During the course of my multifaceted life, I have met many interesting people, principles and conditions. Some of them re-occur so often that I can predict them with reasonable accuracy. One of such is the appearance of issues completely unrelated to cancer at our Medicaid Cancer Foundation medical outreaches.
Thus, I wasn’t really surprised to see this elderly woman holding a physically disabled child in her arms and blocking my path during a recent cancer screening exercise in Augie Local Government Area of Kebbi state. I thought to myself, she has heard Matan governor is in town with her foundation that offers free treatment and instant solutions for all and any disease. So I knew she has brought the boy after touring all the local healers and expects I can make him walk. Being a population of believers with neither formal education nor awareness on most diseases, and with little faith in the health facilities at their disposal, that is the thought process of most of my people in Kebbi state.
I looked- the boy obviously had long standing cerebral palsy, a permanent irreversible condition. Yet this mother expects me to proffer answers that I did not have. Answers, that modern science itself does not yet have. Such expectations can be burdensome and one gets fatigued like I was that afternoon. I am after all, only human.
Yet there was no way I could walk past this woman and her grandson. For starters, I have sworn a Hippocratic oath which binds me to assist any needy person with my skills at all times. Secondly, I am bound by the oath of marriage to the chief executive of the state who has sworn to uplift the life of this woman and child and so I am indirectly compelled to stop.
Thirdly and most importantly, because of the child who has the most heartwarming smile across his face that could stop the fastest moving train. So I lived up to my responsibilities and stopped to listen. She was confident we could help him walk. The reality was that I could not. His was not a case for a cancer screening outreach. I turned to Khadijat Sama, my hostess and wife of Augie LGA chairman to discuss with me further so that we can send him to a bigger general hospital.
The life of a wife of leader is not one of glamour. We exist in an ocean of unending need, waves of expectations and grainy resources. With an efficient team it is easier to follow up and keep track. The wives of the 21 local government chairmen in Kebbi state have become my able lieutenants. They exemplify the words teamwork, unity and success.
As a result, I was not surprised when Khadijat sent me a message the next night at 10. I squared with her and gave her a mini lecture. Cerebral palsy, CP, is a permanent condition that makes movement, posture and coordination difficult for affected children. The condition is caused by damage that occurs to the fetal brain usually before, during or around birth. The causes are often unknown. What modern medicine offers them in is supportive care; physiotherapy for the chest and limbs, movement and hearing aids, drugs to reduce stiffness seizures and spasms and so on.
We don’t have the high end of these supportive aids in Nigeria, but we do have the basics. Even when resources are available, the line of management to pursue is a tough decision for policy makers, doctors, parents and caregivers to make. The NHS (the excellent but often unappreciated British health insurance system) spends a minimum of £60,000 per annum on each child with CP. Almost N30m. That figure doesn’t include the cost of new operations to improve mobility like Selective Dorsal Rhizotomy, SDR, which are now being offered on the NHS.
It is a tough decision for executives to make if to plunge such resources into one life or spread it and save many more with simpler ailments. If I put in my context, I can cure and save the lives of almost 10,000 children yearly from malaria fever with that amount. The dilemma is no less for parents. The average lifetime expenses for the family of a child with CP can go up to one million pounds. Parents have to decide- do they keep such children at home surrounded by love?
Armed with a fair understanding of the health facilities she would have been to, I asked the wife of the chairman to find out how his mother moves him around. She came back within five minutes to give an expected answer, carrying the child in her arms. The next day we sent him a wheelchair, some food and toiletries. The family was ecstatic with our little effort. They had some respite. We screened 530 women in Augie. It took weeks of planning and resources to achieve. However, the greatest impact we made, was on Yusuf’s life with a simple, unplanned gesture.
I took away some lessons from the narrative above-the need to simplify our approach to problem solving. Yusuf does not need a highly specialized physician to make his life better, he needs a competent physiotherapist, a competent social worker and an ingenious occupational therapist. He needs supportive care. Yusuf’s physical problems are as complex as our health system. Yet he has survived this long on the simple but strong support structure of his mother, carrying him in her arms, with all the love she can muster.
Typical Nigerian parents push children to be lawyers and doctors forgetting the vast number of careers we lack in our country. We no longer have proper guidance counselors in our educational institutions. We need more physiotherapists, speech therapists, orthodontists, biomedical technicians, logistic and supply chain managers…an endless list.
We have to start with the simple solutions, grab the low hanging fruits by fixing the primary health care level and excel in that. That is when we can hope to stop seeing the late stage complicated and end of life presentation of diseases that is common place to doctors in developing countries.
Dr Shinkafi-Bagudu, Paediatric Consultant, Wife of Kebbi State Governor Founder Medicaid Cancer Foundation
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