Day 1, Friday 18th 2022
Reverend Father M: My brother is not well.
Me: Oh my God, where is he?
Reverend Father M: Lokoja… In a hospital in Lokoja.
Me: So, what do the Doctors say? What is the diagnosis Father?
Reverend Father M: The Doctors say it is ordinary Malaria.
Me: When did all this start?
Reverend Father M: About 3 days ago. He was admitted to the hospital with fever and feeling unwell.
Me: Is it Covid? Have they done Covid-PCR tests to exclude Covid 19?
Reverend Father M: Oh yes – severally. He is Covid Negative.
Me: Okay, that is good. But wait, where does he live?
Reverend Father M: Idah. However, he is admitted in Lokoja.
For those who may not know, let me explain the relationship between Idah and Lokoja both of which are in today’s Kogi State in Nigeria. Idah is the traditional capital of the Igala people while the confluence town of Lokoja is the present-day capital of Kogi State. According to my Google Maps, Idah is about 2 hours to 2 hours and 30 minutes’ drive or approximately 105.1 km from Lokoja, depending on traffic.
The conversation between my friend and I, drifted onto other things. But the mobile phone remained glued to his ear as he talked, walked, and worked to keep track of things concerning his brother in the hospital many miles away from where we were.
Day 2, Saturday 19th 2022
Reverend Father M: My brother is still not well Loretta!
Me: So, what are his Healthcare providers saying now?
Reverend Father M: They say it is drug resistant Malaria, that’s why he did not respond initially.
Me: Hmmm… Should we be transferring him to Abuja?
Reverend Father M: The Doctors say he is getting better now. That the drug resistance, made the Malaria complicated, but they are winning.
Me: But I am quite suspicious of Lokoja….in fact the whole Kogi State and that your Governor Sir, who does not understand the meaning of providing basic facilities. There may be dedicated Healthcare providers, in Kogi, but they are constrained, overwhelmed and flustered. Will they deliver care with their hands?
Father, I think we should move him to xyz hospital in Abuja. They may be expensive, but at least we can be sure that they know ‘what time it is’ with respect to patient care.
My mono-lecture to my pensive solo-audience of inadequate healthcare in Kogi and in Nigeria at large, despite the zeal of many healthcare providers on ground was interrupted when his mobile rang. Father M talks for a while with the person at the other end. Then announces to me that it is his other brother who is updating him.
Reverend Father M: The doctors believe that our unwell brother is now responding to treatment.
Me: Hmmm… okay then Father. Maybe, we should not transfer him?
Reverend Father M: Maybe not …… now they say he is getting better.
Once again, the mobile phone continued to be an ear accessory for my dear Reverend Father friend. It was clear that he was worried about his brother despite the reassurance of the Malaria treating doctors from Lokoja.
Still the ever-resilient University of Benin Alumnus that he is, coupled with the stoic training of being a Catholic Priest, Reverend Father M entertained and hosted about six University of Benin Alumni members who congregated in his Parish House from around the United Kingdom that weekend.
Day 3, Sunday 20th 2022
I saw Father M before he went to say morning mass in the church. He held on to the hope of reassurance from the Lokoja Healthcare providers. They asserted that the resistant malaria would pose no resistance anymore to their superior pharmaceutical knowledge. At the same time, he remained glued in Faith to God for our brother’s divine healing.
Later that Sunday night, I got a frantic call from Reverend Father M.
Reverend Father M: I just finished speaking to my other brother. The doctors are now suspecting Lassa Fever
Me: What? Oh my God (my worst nightmare that something was amiss was becoming reality).
Reverend Father M: Yes. They have sent blood samples to a Laboratory in Lagos State.
Reverend Father M: But they have said we must arrange a transfer now to Irrua Specialist Teaching Hospital. So, I am worried. Do you know any one there? We really do not know how to go about it.
Me: Not to worry, I will add my classmate to this call. He is working in the Infectious Diseases Unit at Irrua which caters for Lassa Fever.
I was relieved to hear my colleague’s unique boisterous voice over the phone. We explained to him. He directed that the anti-viral start dose of Ribavirin be given intravenously, and we mobilise to get the patient across as soon as possible. They would be on standby to receive him. He handed the phone to one of the top hospital administrators who happened to be with him at the time. Together, they reassured me and Reverend Father M that they would do the utmost best and that we should move the patient first thing - as the cock crows on Monday morning. My task was to send the details of the patient’s name, age, date of birth as well as hospital from which he was being transferred to them. Father M and his siblings were to arrange the ambulance for the transfer.
As I awaited the details, I fell asleep with my phone still in my hand. I woke up about an hour after, looked on my phone. No message from Father M. So, I called him.
Reverend Father M: They said there was no fuel in the ambulance because of fuel scarcity in Nigeria and that a tire was bad. So, we were trying to sort all that out. I will send you the details of my brother to pass on to the Irrua Doctors we spoke with soonest.
Me: Okay. I am waiting.
I fell asleep again. I woke up, to search for the expected message. But the message I saw, elicited a scream from my lungs. It read, “My brother just died” it was sent at 10:52 pm United Kingdom time – 11:52 pm Nigeria time.
Immediately, I called his number.
Me: Father, I am on my way to your house!
It was just Malaria on the first couple of days. After which it became drug resistant Malaria down the line. As at when he died, we were not sure what killed him. However, the laboratory result from Lagos, confirmed Lassa Fever a few days after his death. I feel a huge sense of ‘some sort of responsibility not taken’ that I did not follow through and insist on my idea to transfer him. Would that have saved our brother? We can never tell now because he is dead! He is dead and we can never correct for that experiment.
This is a real-life example of how our fellow patriots are felled by the Malaria axe, day in day out in Nigeria and sub-Saharan Africa. Our healthcare provision without knowing it, has become hung up on, hung onto and hung out with Malaria. However, you look at it, Malaria is our bread and butter. Even when Malaria screams out loud ‘I am not present here – look elsewhere’ we do not listen. We force all our symptoms into the Malaria box. We then exotify the type of Malaria. You hear ordinary Malaria, uncomplicated Malaria, drug resistant Malaria, complicated Malaria and pre-fixes of all kinds. Treating a patient with febrile illness lasting a week for Malaria without quickly thinking out of the box after two days is to say the least, “interestingly interesting”.
However, if I am honest, in Malaria endemic regions, it is important to think – “Malaria until proven otherwise”. The problem arises when we do nothing, proactively and speedily to prove the otherwise. We are fixated on Malaria and the companion – Typhoid fever. In fact, most times, they are said in one breath “Malaria and Typhoid”. Sadly, there are many other illnesses that begin their manifestation just like Malaria! Chicken pox, Measles, Covid-19, Lassa Fever, Hepatitis, HIV, Leukaemia, Multiple Myeloma, Pneumonia, even good old Sepsis can start out just like Malaria. This list is by no means exhaustive. In fact, it has not scratched the surface.
Lassa Fever killed our brother! Lassa Fever is an acute viral haemorrhagic (bleeding from various parts of the body in advanced stages) fever spread by rats. It is curable if caught on time and we act in a timely fashion. Lassa fever is a zoonotic disease (humans become infected from animals). It is named after the town of Lassa in Borno State and is endemic to our country with peak time cases observed during the dry season (December to April). This peak period is when we clear and set fire to the farms in preparation for the next season of planting. The rats, carrying the virus, then seek shelter with us in our homes. They come in, urinating, excreting and frolicking in exposed food stuffs and surfaces. It is highly contagious via blood, other body fluids and other secretions. Symptoms will appear between 6 to 21 days after infection and most patients if untreated, will die within 2 weeks of the emergence of symptoms. It is a disease of major public health concern where prevention is wiser, cheaper, and better than cure. There are currently no vaccines available for this condition.
Fatality is one percent of all cases and about fifteen to twenty percent of patients who are hospitalised will not make it out alive. Time: the speed of intervention is life. Sadly, our attitude to time in Healthcare as Nigerians is abysmal. We are either jokers or plain wicked. I can already hear you my dear reader, calling on Government to help us determine what is Malaria and what is not. Before I stop writing to cry me a river as our brother is buried, let us look at the kind of impedance to healthcare that promotes the many faces of continued Malaria treatment in our clime even when it is not Malaria, and we can decide which portion of the blame is ours and which is the Government’s?
Phase 1 delay: Delay in decision making by the individual.
Our own healthcare seeking behaviour as Nigerians is impaired by our socio-economic societal strata, our cultural and religious leanings. The people are wary. They do not decide to assess healthcare on time. They self-medicate for same Malaria; they go to Church /Mosque / Shrines for drug resistant Malaria, and it is when things start getting complicated that they may consider formal Healthcare facilities.
Phase 2 delay: Locating and getting to a medical facility.
Finding the right facility for our symptoms or suspected problem is often an uphill challenge. We do not know who provides which service. Maternity homes claim to do Neurosurgeries while Pharmacists sometimes double as Pathologists and Medical Laboratory Scientists - dishing out the twin diagnoses of Malaria and Typhoid. Then by some stroke of luck, we find the proper facility and the next problem is how we can get to it. The huddles of poor road, no fuel, distant travels, and the cost stare us in the face.
Phase 3 delay: The presence of skilled care at the facilities.
Then we arrive at our saving facility, but we find that there is not the right skill mix or even no skill at all to manage the patient. How quick they refer to another facility may be what will make the difference to whether we live to tell our tales, or we die and speak no more.
Often, these Phases overlap and a combination of two or all may be the problem. However, after reading my simplification of the issues above, we can figure out how most of our problems can be solved. It is not rocket science. We can also tell that Phases 1 and 2 were not the major problems of our brother. Phase 3 is what put the nail in his coffin.
To live in the hearts of those who love you, is not to die. Our brother’s death cannot be for nothing. Soucy Ocholi Umameh, at 44 years, your death is representative of many Nigerians who have gone before you and who are this moment going with and after you, because all we see is Malaria. We do not speedily and proactively look outside the Malaria box as we should. Let your death serve as a reminder for us (Citizens, ‘Rulers’, Leaders, Healthcare providers and the Policy makers) to have a low threshold to respond and always look beyond the many Malarias of Nigeria because as one of my colleagues has been preaching in our Country’s Healthcare Wilderness, the Nigerian Patients are worth it. So, let those who have ears, hear because, at the end of the day, anyone of us, can become the patient at any time t!
Rest in Peace great warrior of Kogi State - Soucy Ocholi Umameh
#thenigerianpatientsareworthit
Dr Loretta Oduware Ogboro-Okor is Author of the book My Father’s Daughter