note: Welcome to the Global Health page. The purpose of this feature is
to raise awareness of global health issues with an academic spirit to
help improve the quality of care provided to patients. E-mail
by by Anyanime
Asuquo Edem, College of Pharmacy
Ginika Biko Ikwuezunm, College of Medicine
Traditionally, Nigeria, like most African nations, depended on
herbalists, medicine men or “juju doctors” who were trained to
identify, prepare, administer and cure ailments using herbs and roots.
The advancements of modern medicine and western influence have
mitigated such practices in exchange for contemporary avenues of
Those who can afford it
rely on medical professionals rather than the herbalist. Some patients
choose to combine herbs with medications. A Nigerian doctor may even
discover ritualistic markings on their patient, an important clue to
the past medical history of prior visits to the juju doctor.
Despite efforts to
modernize medicine, Nigeria still has pressing health issues that
include malaria, yellow fever, tuberculosis and AIDS. Amidst all of
these problems, the most pressing and fundamental issues of health and
poverty have been neglected. These forgotten issues, primarily
cardiovascular disease and mental health, have received little mention.
However, if unchecked they pose a major issue to Nigeria’s overall
success. A few Nigerians have chosen to take “the road less traveled.”
Dr. Ernest Madu, a former Vanderbilt cardiologist, is one of those
individuals advocating a fresh perspective to address matters of the
heart. He believes that people in developing countries like Nigeria
have the right to high quality care.
pipelines run through a village in the Niger Delta.
“The quickest way to kill the progress of a
country and spiral into a cycle of poverty is to kill the parents,” he
remarks as his thick Ibo accent booms over the loud speaker during a
conference for progressive thinkers called TED (Technology Education
is the second leading cause of death behind AIDS in sub-Saharan Africa
and the leading cause of death for individuals older than 30 in the
region. It would appear that Madu’s assertion is true as the past
Nigerian President Alhaji Umaru Yar’ Adua became the latest high
profile Nigerian to fall victim to chronic heart and kidney disease at
56 on May 5, 2010.
trained in the U.S. and U.K., such as Madu, have opted to make
specialty care in developing nations a reality. Utilizing innovations
such as a telemedicine platform in his facilities, Madu consults
physicians from around the world to address the most complex cases,
giving optimal care to these patients.
In addition to cardiovascular disease, mental health issues have
reached a boiling point in the country. Initially, like many other
Nigerians, we ignored these issues and looked at the indigent
population who are ambulating the streets as a public nuisance. I
(Ginika) remember visiting Lagos last December for Christmas when one
of these so called “mad men” accosted our vehicle and an episode that
is commonplace in Nigeria and many African countries ensued. Among the
herd of cars and okada (men on motorcycles) snaking
through the congested streets, one of these “mad men” approached. He
was visibly disheveled, so we assumed the position. This meant looking
forward and ignoring the gentleman in hopes that he would eventually
leave. This effort proved futile, as he became agitated, pounded on the
window and extended his hand demanding, “yem ego!” or give me money. We
eventually gave into his request.
However later, while
recounting the event, we became cognizant of this personal stigma that
we experienced with our respective families. In Anyanime’s case, her
personal experience involved a neighbor, while my experience was with
my uncle, Kristopher, whom we called “Teacher.”
The inhumane treatment
of these people we loved was utterly devastating, but reconvicted us
with the responsibility to raise awareness about these issues and
engage in local outreach.
Nigeria, like the U.S.,
has its own unique challenges with a complex economic and political
However, it is our duty to ensure that our loved ones are not among the
forgotten. In spite of all its idiosyncrasies and frustrations, ask any
Nigerian and they will proudly tell you, this is home.
Facts about Nigeria
- Population: 154.7
million (UN, 2009) (The most populous nation in Africa)
- Government type:
Federal Republic Nigeria is one of the OPEC nations..
- Area: 923,768 sq km
(356,669 sq miles). 2.5x California
- Year of Independence:
Oct. 1, 1960 from Great Britain
- Seasons: Dry
(November to March) and Wet (April to October)
- Endangered Species:
Drills Monkeys are denizens of the Cross River State, Nigeria
- Health Care: Nigeria
has a three-tier health
care system. The Primary receives lo- cal and state government support.
Secondary care is more specialized using referrals via outpatient and
inpatient services. Tertiary care is centralized around
highly-specialized services with a teaching hospital such as MUSC
operating as a hub. In principal, this system works, but the critical
issue is that government funds are misappropriated.
A 32-year-old female student from Nigeria presented to MUSC with a two
day history of fever, sweats, headaches, chills and eye sensitivity to
light. Her temperature was 101 F, pulse 110 per minute but otherwise
hemodynamically stable. Examination revealed a soft ejection systolic
murmur and signs of meningism, but her neurological status was
otherwise normal. She noted that she suffered from a new onset anemia
and did not use a bed net while in Nigeria. Of note, a review of her
body systems was positive for intermittent fever (every 48 hours),
fatigue, nausea, vomiting, diarrhea, abdominal cramps and joint pain.
What is the likely diagnosis?
A. Dengue fever
B. Malaria. This
infection is caused by the protozoan (parasite) Plasmodium falciparum
parasite. It accounts for 98 percent of malarial infections in Africa.
The parasite lives in the gut of the female anopheles mosquito and is
transmitted when it bites a human. Treatment with artesunate and
sulfdoxine-pryimethamine is indicated in uncomplicated cases. For this
severe case IV or IM artesunate/quinine is effective. Prevention with
bed nets is indicated.
Facebook: MUSC International Programs
Friday, Feb. 4, 2011