WHERE are Dr. James Egejuru and Dr. Adekola? I remembered them two weeks ago when the wife of one of my nephews was delivered by a hospital in Somolu, in downtown Lagos, of preterm twin baby boys. One of the babies died, in my view, unnecessarily. I believe the death was avoidable for a number of reasons.
ONE: His mother had been shown by a scan probe to have a narrow pelvis or birth canal. This made her a most likely surgery candidate, especially because the babies were twins.
TWO: Surgery was undertaken several hours after she had begun preterm labour with evidence that she couldn’t on her own give birth to the babies. Apparently, the hospital had no surgeon and had to depend on a shuttle surgeon, who was probably busy in another hospital nearby, to offer shuttle surgical services of the kind required in this case.
THREE: After the babies were born, they were not immediately placed in incubators, as a procedure which guarantees a higher degree of survival potential. In fact, the surviving baby was referred to another hospital after its twin had died. Before the death, both had been wrapped with clothes to insulate them from heat loss, and a kerosene lantern was placed near them as a heat source, improvising an incubator.
FOUR: All through the first night, there was no doctor around to keep an eye on these babies, who were struggling to live, and the nurses retired to the Nurses’ Bay to pass the night . A lay woman, who kept the vigil around the twins on behalf of their parents, reported in the morning that one of the young ones had breathing difficulties all through the night.
All she could do was clean mucus from the nose and mop foam in the mouth. It would appear that the mucus extractor the hospital asked the parents to furnish was of little, if any, value. And by the time the regular nurse reported for work in the morning, the baby had died.
FIVE: It was at this point that the other baby was referred to another hospital with incubators on the second night of its birth. He weighted 1.3 kilogrammes, too small to survive on its own. There was no ambulance to help this baby. The father and mother hired one taxi after another shuttling from one hospital to another in search of an incubator. In some hospitals, last incubator had either just been taken up or broken down. After combing Lagos Island to no avail, they came down to Ikeja on the mainland. A popular hospital in Ikeja asked for half a million. But they hadn’t seen this sum of money all their life. In any case, where would they find a quarter of this money that night as a deposit? Another hospital nearby had no incubator. But it charged N250,000 and offered to book the baby in and then transfer him by ambulance to another hospital which would look after him. Just as time was running out and hope appeared too slim to hang on to, the parents sighted another hospital on Adeniyi – Jones Street, which offered an incubator and paedriatic service for N100,000 a week. With joy the parents handed out the baby and paid N40,000 deposit. The doctor carried out some tests, which showed that the baby had a fairly good chance to survive.
As I write, the parents have paid N75,000 and are running helter – skelter, as we say, to offset the N25,000 balance and another N100 for the second week. Meanwhile, the baby is now rosy and will be taken home any time the parents can find the money. When the baby comes home, the mother would have to be bailed out of hospital, where a bill of about N130,000 has messed up after the doctor discounted N30,000 off, following pleas.
As I write, I remember the scary picture of something like an epidemic of preterm babies my nephew painted in the narration of his experience. Everywhere he went that memorable night, he saw many parents in his shoes hither and thither searching for help or leaving in disgust, either because there were no incubators for them, the available ones having been occupied, or because they could not afford the bill. In some cases, some babies died in the hands of their mother or father and the bodies had to be disposed off somehow. From this scenario, it is logical to conclude that something is going on in many pregnant women’s wombs, which are making unborn babies to be born prematurely. I wonder, as I think about my nephew’s case, if his trauma could not have been avoided and if his other boy could not have survived had the hospital handled its patient differently.
ONE: What was a pregnant woman with small pelvis, who would require surgery to have pre-term, low weight babies, be doing in a hospital without incubators; why was she not referred to a more competent hospital.
TWO: If, for the sake of argument, we concede that she arrived that hospital in pre-term labour and surgery was dictated by a medical emergency, why were the low weight babies not referred immediately to a more competent hospital?
These were the questions which reminded me of Dr. James Egejuru and Dr. Adekola. I met them in the 1980’s when they worked at Duro Soleye Hospital on Allen Avenue, Ikeja, Lagos. Dr. Egejuru was a pediatrician, Dr. Adekola, a surgeon. They are professional and humane doctors. Dr. Egejuru later moved to Stephenville Hospital, which I understand is his, while Dr. Adekola went to manage Igbenedion’s Specialist Hospital at Okada. Dr. Egejuru worked day and night. His wife would sometimes come to drag him home for dinner and, soon after, he would return. If the incubators were filled up, he would, like a woman, strap a premature baby on his back, and continue his rounds. Only once did I see him beaten hands down. The case was that of a woman who worked at the Lagos State Government Secretariat at Alausa, Ikeja, whose jaundiced baby had to have three exchange blood transfusions (EBTs). EBT candidates have abnormally high level of bilirubin in their blood, which the liver couldn’t clear and which can damage the brain. Bilirubin is the yellow component of the red blood cell. It pours into the blood stream when red blood cells die and are broken up for their debris to be conjugated by the liver. If the liver does not function fast enough, or red cells are breaking up faster than expected, as in Malaria, Yellow Fever or Sickle Cell crisis, a bilirubin accumulation occurs which cause yellowing of fingernails, eyes and skin in varying degrees of seriousness. In EBT, some of the bilirubin-infested blood is drained out and bilirubin- cleared blood from a donor is given to the patient. The stubborn case in reference defied three EBTS. The mother then requested discharge, against medical advice, to treat her baby at home. I researched bilirubin when my first child was born in 1984 and he had to undergo phototherapy (exposure to special light) to clear his bilirubin. And by the time the other children came along, each one bilirubin-challenged, I had learned a few anti-bilirubin tricks which worked for them. Well-wishers often bring a newly delivered mother sugar-laden beverages and glucose. These complicate matters in my view. I withdrew that from the bedside cupboard and replace them with marigold tea in the flask and sweedish bitters. There were taken by the mother and fed to the baby in breast milk. Once; I tried Aloe Vera Leaf gel. It ran the baby’s fragile tummy, so I stopped it. Maybe I scooped some of the yellow sap with the gel. The yellow sap is described by the FDA as cathartic, that is violent on the intestines. Unfortunately, it is a major component of many popular bitters on the Nigeria market today, which claim, with good reason as explained, to help people move static bowels. But who likes to move sluggish at the risk of violence on his intestines? Instead, I recommend safe bitters as Maria Treben brand, which is scarce. Today, the bilirubin-challenged person is luckier because there are now many good liver formulas on the market. The mother of a jaundice-infested baby can take food supplements such as Marigold Tea; Wheat grass tea; FLP’S; Aloe Vera gel; Milk Thistle; Liver balance; carquefa tea; Stinging Nettle tea; Yarrow tea or capsule; Jerusalem artichoke; Apple Cedar Vinegar; Swanson’s Liver Essentials; burdock root (in mild dosage); Veruain tea or capsule and many more. They help to tone and strengthen the liver in diverse ways, stimulate the production of bile and improve liver function. I could not discuss this issue with the woman whose baby failed to respond to three EBTS because we were in a hospital environment. Even the doctors at Duro Soleye Hospital at that time declined honey for my wife because they weren’t sure of the ‘purity’. To cut a long story short, the EBT-baby mother took her baby to Epe, her home town, where the infant was treated with Italus water extract of what the Yoruba Southwestern Nigeria call it Ewe Iran or Ewe Ariba in Ijebuland.
Dr. Adekola is a surgeon who wears no intellectual airs around him. He dressed simply in short-sleeved shirts and a pair of trousers. He had no car and mixed freely with the bus-stop crowd. He shared a flat with his sister and visited his patients at home cost-free. He let me into the labour room when my second child was coming. The baby was coming bottom first. I shed tears when I witnessed the pain his mother was going through as he tried to adjust his presentation to normal. I asked Dr. Adekola to carry out surgery. He declined, smiling, even as I threatened to sue him and the hospital if a mishap occurred. I learned a lesson from his intransigence. I began to pray; how often do we not forget to pray when we reach the limits of our capacity? Today’s surgeon would not wait for my request. I understand that in many hospitals today women in labour are not given the opportunity to have their babies naturally. It has to be through surgery, and the bill is hardly under N150,000.00. Our baby came naturally and Dr. Adekola became our family friend. When I learned he was in Okada, I paid him a visit on my way back home in Lagos from Benin. We lost contact after that.
Preterm labour
There are many possible causes of premature labour. These include hormonal imbalance; weak cervix; infection and excitement of uterine muscles; nutritional deficiencies, and stress of varying degrees, plus inadequate preparation of the reproductive system for the ardous task of pregnancy. Traditionally, doctors gave I believe they still do, synthetic progesterone hormone injections or cream to bring the ratio of the hormone at pars with the ratio of estrogen, its count lever. Hormonal balance is crucial in these matters for the placenta, which feeds baby, to be maintained. But, increasingly, many studies have failed to justify claims that this hormone can arrest preterm labour once it starts. Twins are likely to arrive pre-term unless, perhaps, if there is a surfat of pregnancy-maintaining nutrient’s paraphenelia. Hospitals give basically calcium and iron to pregnant women. Compared with the assembly of nutrients in PREGNANCY CARE or PRENATAL food supplements, for example, this is child’s play. Even then, the hospital’s calcium is low grade inorganic calcium, which the body cannot absorb or use efficiently, In its place, I’d suggest CORAL CALCIUM. CORAL CALCIUM is multi-nutrient calcium, which includes magnesium, phosphorus, boron, zinc and about 40 other micro nutrients in the way Mother Nature designed them to combine with calcium. Pharmaceutical iron is also inorganic. It cannot be well-utilised by the organic human body, which must nourish and maintain itself with organic materials for optimal health. Which Pharmaceutical iron brand can beat the organic iron content of say, Jobelyn, Blackstrap molasses, Bect root or Spirulina? Two teaspoonful’s of black strap molasses every day are reported to provide 40 per cent of the daily iron needs of an adult. Given them to children and ageing people helps them to overcome iron-deficiency anaemia, tiredness and poor growth in children. Some, if not all menstruating women, may need to top up their iron level after every monthly cycle. Cerclage, or cervical stitch, may help incompetent cervix, which literally speaking, make the baby to fall out. It is like a bottom of a full bottle coming off and making the content pour out. The matter would be better addressed in my view, the day the causes of incompetent cervix are known and addressed. Does it, I wonder, have anything to do with weak nerves and muscles? Can lion’s Mane, which increases nerve energy and health work for the cervix? Will Coenzyme Q10 and Vitamin E, with tone and energise muscles work for the cervix? I know some women who suffered from habitual or spontaneous abortion, but who went on to have normal pregnancies and birthing while they took magnesium atrate food supplements. It is not surprising. Magnesium calms the nerves and relaxes the muscles.
