It is a common sight in Badagry, one of the riverside areas of Lagos state, to find many residents with swollen necks, especially in of Ajara. It is not an evidence of good living as some might want to say, as the people affected would love to have a normal neck, devoid of any swelling. But a prevalence of goiter disease now ravaging the community would not allow this.
Wherever you turn as you approach Badagry roundabout from Lagos, either right to Ajara or left to the ancient town made famous by the slave trade of the colonial era, you are likely to be confronted with the sight of men and women, old and young, married or single with unusually large necks. They are suffering from goitre, a disease that causes an enlargement of the thyroid gland (around the neck). It is called ‘kojiji’ in the local dialect.
The Nation gathered that the disease is endemic in the area especially in the 14 or so communities that make up Ajara, with pockets of it elsewhere in Badagry. And expectedly this is causing concern among health officials in the area who are worried about what could be the cause. The state government is equally worried and has set machinery in motion to not just unravel the cause but also rid the area of the ailment.
Most of those afflicted have been carrying the disease for years, some for decades with no clue as to the cause and how to get cured. Most attribute it to spiritual attack from their enemies and believe only a spiritual intervention could cure them. Some have resigned to fate believing it is their own cross in life to carry. Over the years, they had attempted different manner of solutions. From scarifications of the affected area which could be right on the frontal neck or beside the neck; to carrying out of sacrifices and eating all sorts of preparations, made from herbal plants, drinks or even of animal origins. Yet there were no improvements.
Though the disease has been among the people for long, the upsurge was only noticed about few months ago when the state government dispatched a health mission to the area as part of its health care programme. Almost immediately a course of treatment was put in place including free surgery for those affected at teaching hospital in Ikeja, the state capital, while a team of experts was put together to determine the cause.
The experts it was gathered have been to the area and have almost concluded analyses of the samples they collected from the water the people are drinking and the screening of the pupils in the community school, with a view to detecting the causes and preventing a reoccurrence.
Sharing her experience, an expectant mother, 40-year-old Mrs Pauline Edokpaye, who had lived in Badagry for six years, said she began to notice some swelling around her neck, four years ago. She was uncomfortable with the development, but did not understand what it was all about until she visited the General Hospital, Badagry, and was told it is called goitre.
“Since then, I’d visited many other doctors who prescribed medications and I have also seen traditional healers who gave me things to drink and did ‘gbere’ (incisions) on same. But I never saw any improvement until last December when I attended the Health Mission and I was discovered and selected as one of the beneficiaries for surgery”, Mrs Edokpaye said.
But she would however have to wait for a while until she delivers before her surgery can be carried out.
But for 37-year-old Chika Ahamefule, who had also lived with the swollen neck that she described as: “a reproach for me and my family”, it is a different ball game. She had lived with the condition for three years.
She did not understand how it all started, but all she realised, according to her, was that her voice began to change and the once beautiful Church chorister was no longer able to sing: “Because my voice had changed and it cracks a lot with some vibration that rings to my earing”. Chika is one of the first set of the 43 beneficiaries, who have had their enlarged thyroid removed through surgery.
The Nation gathered that while some residents believed they contracted the disease known as “Kojiji” in local dialect, because they use cup to drink from the stream in their rustic Ajara community, some are of the opinion that they came in contact with goitre through supernatural powers said to be rampant in the community. Not even scientific explanation for the cause could convince them otherwise.
Some blamed their infertility on the disease. One of them, Mrs Victoria Abimbola, said goitre was a spell from evil people in her community which prevented her from having more children as she would have loved to.
She said: “In fact, it was this disease that stopped me from having more children as I had planned before my husband died. I was told by a source I consulted, it was this disease that prevented me from having as many children as possible. I want God to remove the disease that has turned me to a subject of ridicule in the village. I have used traditional and orthodox medicines. Many have taken advantage of me and duped me. They have collected all I have, claiming to have solution to the problem.”
A septuagenarian, Mrs Hanna Apata, who had been battling goitre for over 30 years, also claimed that she was attacked by evildoers in the community.
According to her: ”My children have been frustrated over the expenses on the treatment. In fact, I could not tell them that I was coming for this treatment. My husband tried his best before his death 10 years ago. It should be closed to 30 years or more that I have been suffering from goitre. I do not use drugs. Goitre is caused by the evil people. They cast the spell on those they perceive as their enemies. That is all I know. So I believe the best way to deal with it is through spiritual means.”
Fumilayo Adeyemi, said the spell, which she thought was cast on her, was meant to hinder her kidney from functioning normally. The woman added that herbalists told her that her goitre was as a result of kidney disorder. “I have been suffering from the disease for over 10 years. I have spent all my money on it. There are many fraudsters who have taken advantage of us; some said my kidney was not functioning well. Majority said it was a spell by enemies and witches, everybody has his own reasons for the cause of the disease,” she said.
According to Elizabeth Akintunde, another resident, who could not recall the year she started to live with goitre, said she gave birth to four of her five children with the disease.
She said: “I have used drugs especially traditional medicines prescribed for me. Many people have come to us to tell us that if taken, the disease would be cured. But we pray the government will remove the swelling, may God assist them in doing so. I have spent a lot of money in a bid to cure it.”
Speaking at the flag off of the surgical intervention for those suffering from goitre at the Lagos State University Teaching Hospital (LASUTH), Ikeja, the Commissioner for Health Dr Jide Idris said it was still not certain what could be responsible for the large number of people with goitre in Ajara community.
According to Governor Babatunde Fashola, who kicked off the free medical intervention, “we became touched by the plight of these people who do not even understand their situation and have decided to help them find out the root cause of the problem and proffer lasting solution.
“As a preliminary, we are offering free surgical intervention and henceforth all health missions shall include goitre screening across the state and free surgery as well”, he announced.
According to the governor, the government is not stopping at treating the patients alone but, “wants to find out how to prevent people from developing such a condition. Hence, we have sent experts to that area of the state to discover the root cause of such. We will be using children to determine the cause in line with international standard.
“Also, epidemiologists from the state, public physicians and other stakeholders will be storming Badagry to detect the reasons why goitre is so rampant there. The findings will help us to take action in preventing our people and future generations from developing the disease.”
According to Dr Idris, the discovery of goitre in Ajara was made possible by the Medical Mission, which took place last December which led to the large turn-out of people with swollen neck among local residents who came seeking medical intervention.
He said: “Consequently, the ministry constituted a team of experts led by Consultant Surgeon, Dr Bolaji Oludara; Consultant Endocrinologist, Dr Wale Ajala; State Epidemiologist, Dr Ismail Abdu-Salam, and Consultant Clinician, Dr Adedokun, to carry out an on-the spot prevalence study and draw out possible intervention programme.
“The initial finding showed that occurrence of this alarming number of neck swellings in an isolated region was because of the physical and financial burden to the local residents of referring these patients to secondary and tertiary healthcare facilities, it became necessary to develop a comprehensive strategy that will offer an effective and holistic approach, whose impact will be felt in the long term”.
Speaking on the initial findings, Lead Consultant Surgeon, Dr Bolaji Oludara, said a selective, specialised medical mission for the patients which took place between March 10 and 14 found the prevalence of simple goitre in the community with three testing positive to toxic goitre.
Oludara said: “The disease which is the enlargement of the thyroid gland often due to iodine deficiency or blockade of iodine production by certain diets which inhibits iodine to the body was found prevalent among women in the age bracket of 30 and 59 but mostly within ages 40 and 49 with the oldest patient found to be 62 years who had lived with the condition for 45 years. Untreated simple or toxic goitre could lead to heart diseases and eventual death.”
The surgeons from LASUTH told The Nation that their observations of the goitre prevalence in Badagry could be described as toxic goitre.
They explained that such have an array of chemical symptoms and signs that are actually very dangerous to existence. For example, they can affect the heart, cause all sorts of changes, such that the person will be having tremors, the eye balls will be protruding. And when the person like that goes into what is called ‘thyroid toxic crisis’, that can easily cause death, therefore there is need beyond the cosmetics to investigate these cases.
They further explained: “And if we are able to identify the toxic inherent in the goitre that will further help us to pursue aggressive solutions and further treatments. And no Uhuru yet even in any of the people that have ‘simple goitre’. This is because if the simple goitre stays for a long time there is a propensity to develop into cancer on the long term. There is a sure risk of cancerous degeneration in a long standing goitre that has multiple nodes within them. So we need to understand that cosmetics treatment may not be the best bye-pass solution. It is also good to know that a number of cases have real serious medical issues and we are also investigating these cases among the series that we are actually looking at.
“Though goitre prevalence in Badagry is high, but, it is not completely uncommon in our environment. Even at LASUTH we see some number of cases. Unlike some fifteen, twenty years ago, today we are seeing quite an increasing number of cancer within the thyroid gland, some of the specimen that appear to look like simple goitre, when you send them after removal, through surgery for histo-pathological analysis, some of them still come back as Thyroid cancer, i.e a cancer originating from follicular or parafollicular thyroid cells. Thyroiditis and other thyroid disease also predispose to thyroid cancer.”
Ajala explained: “There are four major types of thyroid gland cancer- anaphylactic, follicular, medullary and papillary. The best way to find a thyroid cancer is to make sure that your thyroid gland does not have nodules and is not enlarged. We see patients especially women with protruding eyes, most of the times their hand will be shaking, most of these people are very lean. One thing that is very interesting in this Badagry case is the number of hypo-thyroidism that we saw in them. Like we said, the disease is common in this environment, but hypo-thyroidism is not common at all, when we investigated, we found, that about 15 percent actually have hypo thyrodism, that is, the thyroid gland is working below expectation and it may then be one of the reasons why they have the swelling, it could be that the body is reacting to cell, maybe there is some anti body antigen reaction and we are really suspecting this.”
He added: “About 15 per cent of the cases that we have seen may be having some auto immune disorder. The Badagry case is puzzling being that as a riverside area, the residents naturally have access to an increased supply of iodine in sea food, but the reverse is the case, the state is actually looking deep into it to know what exactly the cause is.”
A member of the team told The Nation in confidence that children were examined as the gold standard in determining the causes of goitre in Badagry, because, Thyroid disease is a common paediatric disorder that affects up to 3.7 per cent of school-aged children, and it usually presents with a goitre.
“By far, the most frequent cause of goitre is autoimmune thyroid disease, although benign colloid (simple) goitre is also a common cause. Our methodology focused on the diagnostic approach to Badagry children (especially with a hypothyroid, hyperthyroid or euthyroid goitre).
“Thyroid disorders are one of the most common endocrine problems in children and adolescents. One American study showed thyroid disorders to be present in 3.7 per cent of children between the ages of 11 and 18 years. Children with thyroid disorders usually present with an enlargement of the thyroid gland (goitre), with or without symptoms of thyroid hormone deficiency or excess. These symptoms are generally insidious in onset, which may delay diagnosis by several weeks to several months. Because goitre is often the first sign of thyroid disease, the diagnostic considerations can be approached from the perspective of the goitre”, the team member stated.
These findings and synergy corroborate the submissions of the Coordinator of the Free Health Mission, Dr. Dolapo Fasawe, who debunked the myths by the residents.
According to Dr Fasawe: “It is unfortunate that these people have refused to go to the hospital over the years and this explains why they all have marks on their necks. The truth of the matter is that there are so many things that can cause goitre; it could be from the water they drink or the food they eat.
“Goitre is the swelling of the thyroid gland situated in the neck. When this thyroid gland starts to malfunction, when there is deficiency, it can enlarge to 50 times of its original size. It could be lack of iodine in the body. It could be in the environment. But we are investigating it to find a lasting solution to the problem.”
Dr Fasawe said government would carry out massive sensitisation to dispel the rumour and the myth concerning the cause of the disease once the team formally submits its reports on its findings.
