|Monday, November 5, 2018|
Harrisburg, PA, USA
was saddened to read about the passing of Sylvester Debe Ojukwu. In the early 80s, we both were students at the university of Nigeria, Enugu. He was studying law while I studied architecture. He was so full of life, especially when Chief Odumegwu Ojukwu returned to Nigeria - the era of Ikemba Front.
Even though I usually saw him on campus, I did not know who he was until he was identified as the son of Ikemba by a classmate of mine. After I became aware of his relationship with a man I respected – Ikemba Nnewi, I often felt an obligation to say hi to him whenever I saw him at the porters’ lodge of Kenneth Dike hostel. After I left the university in 1983, I never saw him again.
I was even more saddened to learn that Debe Ojukwu passed away from sugar-related issues or diabetes – the silent killer. His death from this awful ailment reminded me of a commentary I penned in July of 2009 about diabetes and the havoc it is visiting on Nigerians and the role some unscrupulous doctors are playing in making matters worse for patients. I reproduced it below with some updates. If you cannot read it now, save the article and find time to read it. It is worth it. Here it is:
Many years ago, as a construction engineering inspector in Maryland, I worked with a project engineer, Mr. Buchanan (not his real name) on two bridge projects. Mr. Buchanan had a personal regimen that caught my attention as soon as I joined the project team. During lunch time, when the rest of the engineering inspectors would settle to scrumptious meals with assorted cans of soda to wash the food down, Mr. Buchanan would head into the woods and would not reappear until thirty-five to forty minutes later. It took a while before I found out that he used the entire time to walk two or three miles in the woods for exercise.
On return to the office, he would settle into his chair, gingerly retrieve his lunch from a small Ziploc bag and slowly start eating. His lunch pack always contained fruits. Because I did not understand what was going on at the time, I saw him as a very strange and miserly man that did not want to spend the money he was making to "live well". Considering that he was very well paid, I did not understand why he could not "eat big" like every other staff on the project team. Mr. Buchanan always wore sunshades and did not smoke. He told me that he quit alcohol several years back. As time went on, I began to understand that there was a method to Mr. Buchanan's “madness.” The man I saw as a miser was actually a very wise man. He was doing everything possible to live a healthy and long life. The mild-mannered man was working hard to surmount an uphill but winnable health battle that nature had dealt him. It was during a routine conversation with him that it all began to make sense to me. In a somewhat subdued tone, he said to me that he had lived with diabetes for a while. He explained that an attempt to control and even defeat the ailment necessitated several changes in his life style that included quitting smoking, watching what he ate, exercising regularly and wearing shades to protect his eyes.
Mr. Buchanan also stated that he was always in control of his temperament to avoid spiking his blood pressure. To him, all the precautions he had been taking had proved fruitful so far because in spite of the number of years he had lived with the disease, he was still free from any of the opportunistic ailments like retinopathy and neuropathy. "Alfred", he had said to me, "the greatest gift any man can ask for in life is to live a life free from diseases. When this is not possible because of heredity or other factors, the quality of a man's life depends on the effort invested in the upkeep and maintenance of life. I realize I did not ask to be struck by diabetes but since it can be controlled through what I eat and do, I am going to do my best to control it."
From that day on and as the years passed by, Mr. Buchanan's words of wisdom have continued to make sense to me. The relevance of the above story will become apparent as this commentary unfolds.
I must admit that while I was still in Nigeria, in the early eighties, diabetes was an ailment I knew very little about. I thought it was one of those very rare ailments that struck one in a million in Africa and Nigeria. The reason is because I rarely heard people say they had diabetes or that family members had it. Something must have happened between then and now. It is either there was stack ignorance about its presence in Nigeria before or something in the environment, lifestyle or diet has drastically changed in the country to cause a geometric proliferation of the disease. Since I started visiting Nigeria more often, I have been alarmed at the ubiquity of the ailment in the country. It has come to the point where one believes that as much as half of the adult population is grappling with pre-diabetes or have full-blown diabetes! My conclusion is of course not based on any tested scientific analysis but a small population sampling of the people I come in contact with.
In Nigeria, the Xmas season is always a time to visit friends and families or be visited. It seemed that every single compound one visited, there was always at least one person that had been diagnosed with diabetes or is already suffering one or more of the opportunistic ailments that result from the disease. Not quite three years ago, a distant relative suddenly passed away. He died sometime in April or June of that year but I had seen him the previous Christmas season. We even sat down several times for conversations about general issues. This man looked hale and hearty and the reader can imagine how shocked one was, a few months later, to hear that he had passed away because of diabetes. Since then, I have talked to many Nigerians that concur that diabetes has proliferated geometrically in the last ten or fifteen years, maiming, blinding and killing Nigerians in droves.
Now, what do you make of this heartbreaking story? A few nights ago, I was woken from sleep by a phone call. As soon as I saw the time, I could tell that the call was not an ordinary one. No one would be calling at that ungodly hour if there was no emergency. I was right. It was a relative calling to inform me that diabetes had caused the limb amputation of someone we know. To protect the person’s identity, I will use the name – Benjamin. The amputation was the result of diabetic neuropathy. I last saw Benjamin in December. It was after the news of the amputation that I became aware of the fact that he had been diagnosed with the disease sometime back. Typical of the progression of the ailment, he soon started having a tingling sensation in one foot. The tingling sensation quickly progressed to loss of feeling on that foot.
Benjamin dutifully went to the doctors in one of the respected University Teaching hospitals and got treatment. When the symptoms did not improve, one of the doctors referred him to what they call "icha oku"- heat or thermal treatment. This is where the patient's leg is placed inside an enclosed heat source for a period of time each day. The rationale is that since the loss of feeling is the result of blockage of the blood vessels going to the foot, the heat treatment would help "dissolve" the congealed blood and allow flow again. While he was undergoing this unconventional treatment, he was losing valuable time that could have been used to save his leg. After several of the heat treatments, when it became clear that the condition was not improving, Benjamin was airlifted to India. There, his case was declared critical. The so-called heat treatment had damaged more nerves and any remaining living tissues and quickly progressed to gangrene. The doctors had no choice than to amputate the leg. Update! - Benjamin has since passed away from the ailment after many years of suffering other complications that included stroke.
This story exposes the fact that while there are great doctors in the country that know what they are doing, there are those fly-by-night, “adigboloja” doctors and therapists who have no idea what they are doing. A doctor that sent a diabetic patient to a therapist that “roasts” people's limbs alive, all in the name of therapy for diabetes, is not fit to be called a doctor and families should never send their loved ones to such people.
It is not clear to me whether the medical board in Nigeria is able to regulate the activities of its members like defrocking incompetent ones that send unsuspecting patients to untimely deaths. If there is no provision for serious sanctions for toying with people's lives and body parts, one should quickly be put in place by the medical board. Just as Benjamin unexpectedly lost his leg because of following the wrong course of treatment, so do many diabetic patients lose their sight, sustain kidney damage, become heart patients or even die because they trusted the management of their ailment in the hands of fly-by-night doctors. Treatment and control of diabetes, from what I can tell as a lay person, depends largely on whether the doctor in charge prescribes the right course of action regarding drugs to take, life style and eating habits changes to make.
Mr. Buchanan, the project engineer I talked about in the opening paragraphs of this commentary, had a good doctor. The doctor prescribed the right medications; advised on needed lifestyle and dietary changes. The doctor also followed up with periodic blood tests to ensure that the drugs Mr. Buchanan was taking were not having toxic effects on his kidneys and liver as is often the case with medications that are metabolized in the liver or kidney. The doctor knew when to change Mr. Buchanan's prescription drugs or reduce the dose to avert liver or kidney damage. Nigeria needs more doctors that are knowledgeable, dedicated and not just profit-driven. I am sure we have many of such doctors, but we need to have a way to fish out the scam artists and weed them out so that diabetic patients will not go through what Benjamin went through. Clearly, if it were to be in the United States that a doctor prescribed a treatment course that resulted in loss of limb, that doctor better be ready to be sued and decertified by the medical board for malpractice. We must begin to move in that direction.
Some of the doctors in Nigeria do not even keep abreast with developments in the pharmaceutical industry. They carelessly prescribe healthful but dangerous drugs without monitoring their patients to avoid liver or kidney toxicity. They do not even know when the drugs they prescribe have been recalled so as to warn their patients to stop taking them. For example, one of the drugs that had been used to treat diabetes, in this country and elsewhere, was recently recalled and doctors quickly sent out information to their patients warning them to discontinue the use of the drug. I am almost certain that there are doctors in Nigeria that still use the proscribed drug to treat their patients in Nigeria. It is time for the Nigerian government to declare an all-out war against diabetes. This means earmarking substantial amount of money to make available necessary drugs for treatment. The drugs should be subsidized so Nigerians on the lower rung of the income ladder can have access to them. Also, a substantial amount of the earmarked money should be used for mass education about diabetes. The mass education component of the campaign should include TV, Radio, newspaper and billboard advertisements that address the signs and symptoms of the disease, when to see a doctor, what to expect from a good doctor, lifestyle changes to make once a diagnosis is made, dietary changes and more. Furthermore, the medical board in Nigeria must do its part. It must come down hard on the doctors that give the generality of the brilliant doctors a bad name by their fraudulent practices. Doctors should be compelled to get some sort of recertification before they can treat patients living with the disease. Recertification should include relearning signs and symptoms of the disease and treatment options that advancement in technology has unearthed. It must include relearning the necessary lifestyle and dietary changes needed by patients. Most importantly, recertification should include keeping abreast of new and emerging drugs for the disease and knowing when a drug is recalled so as to warn patients. Also, the importance of constantly running kidney and liver tests on patients placed on diabetes drugs to know when toxicity has set in cannot be overemphasized.
The war against diabetes requires concerted effort from all and sundry. It requires effort from Nigerian doctors and the certification board. It requires effort from the patients and their families.
May the soul of Chief Debe Ojukwu rest in peace