â€” Emmanuel Awa, 14 year-old kidney patient
By Chinyere AMALU
Kidney disease is one of the most silent killers in the world today having no regard to persons, no matter highly or lowly placed. The disease afflicts a sizeable but yet undocumented proportion of the Nigerian population with many saddled with the burden of periodic dialysis.
It is an expensive option that costs an average of N15, 000 to N30,000 weekly. The other option is kidney transplant which costs as much as N8 million where a donor is even available.
Following the activities of the World Kidney Day on March 11, 2010, Saturday Vanguardâ€™s Chinyere Amalu visited a 14 year-old kidney patient, Emmanuel Awa, his widowed mother, Mrs. Nneka Awa and his doctor, Dr. Oluseyi Oniyangi, a consultant in Pediatric Nephrology at the National Hospital, Abuja. Below is the excerpt of the interview.
Emmanuel, how old are you?
I am 14 years old.
What class are you in school?
I am in SS1, right now I am supposed to be in SSII but for my health I am now out of school.
What kind of illness are you suffering from?
My primary disease is kidney failure, but right now I have been admitted because of an infection in my heart, it is just a growth, bacteria growing in my heart called vegetation.
How long have you been in this hospital?
I have been suffering from kidney failure for almost a year now, but the sickness that caused it which is called nephritic syndrome has been on for four years. The nature of the disease is that I go for dialysis twice in a week, Tuesdays and Saturdays. They have to remove all the waste products from my blood through a machine.
Do you feel pains?
No I donâ€™t. The only thing is that I feel week a day before the dialysis, because the waste products have been accumulated again. All the waste and water are accumulated and my stomach swollen up, but after that I feel very strong. My legs donâ€™t swell, but in other children, their legs swell.
Do you have hope that you will be well again?
There is hope for me if well meaning Nigerians come to my aid. Nothing is too small to sponsor a transplant. I can still live a normal life and go back to school to accomplish my dreams.
What are your dreams?
I wanted to be an International Journalist, but because of my present situation, I have decided to study nephrology, that is the disease I am suffering from so that I can help other children that might be victim of it.
Do you have any regret?
I donâ€™t have any regret because I didnâ€™t put myself in this, and I know God is working out something for me. Everything is working out for my favour.
Are you satisfied with the treatment you ‘re receiving so far?
The treatment I am getting here is ok, because this is one of the best hospitals with good equipment in Nigeria. They have all the consultants especially my consultant who is not only interested in my medical, but also encourages me to go on in life. The hospital is good.
We need helpâ€”Nneka Awa, Mother
Ma, how do you feel seeing your son lie on sick bed?
I cannot really say how I feel in my heat because waking up and finding my only son whom my husband left in my care down, I am not happy.
It is by Godâ€™s grace that I have taken it the way I do. As a widow and primary school teacher with meager salary, which hardly sustains my family, not to talk about the huge medical bill, it is really hard for me. With the dialysis twice in a week and with the subsequent kidney transplant I donâ€™t think I can do it alone. So I am appealing to well meaning Nigerians to help this intelligent and aspiring young boy so that he can have a normal life again. His full recovery is not for my own benefit, but for the entire society because he is very intelligent.
How many children do you have?
I have him and his little sister.
How much would it cost to do the transplant?
The hospital gave an estimate of N8 million, which would cover pre and post, transplant. We have not gotten any help that is why am using this medium to seek for help. If anybody comes and give us N20, 000, to assist, it will go a long way to help because each dialysis costs N15, 000, multiply it by two in a week. So, no amount is too small.
Are you satisfied with the treatment he is getting so far?
The treatment he is getting now is helping a lot. The dialysis is like maintenance culture and they are really helping him to keep going. Now that there is a growth around his heart, he is living on antibiotics and it is helping him I can say that the hospital is trying.
Herbal Concoctions, self medication can lead to kidney failure
â€” Dr. Oluseyi Oniyangi, Consultant, Pediatric Nephrology, National Hospital
How is Emmanuel responding to treatment?
Emmanuel is responding to treatment, he is getting better from the sickness that necessitated his admission in the first place.Â However, the underlying factor is that he has kidney disease and definite treatment is kidney transplant, which we have been unable to do so far.
Any plan for that?
There are plans on ground for the transplant, but the issue is fund, there is no fund available for now. As you know, there are possible kidney transplant in Nigeria at St. Nicholas hospital in Lagos and another other option is Aminu Kano university teaching hospital and Obafemi Awolowo University Teaching Hospital Ile Ife.
They have all carried out successful kidney transplants in the country. Fortunately, Emmanuel has a donor; his mother is willing to donate one of her kidneys for her son. So donor is not the problem but to raise the fund. It can be done abroad, but like I said, it can also be done in Nigeria. There is no need taking him outside the country, the decision is entirely on the parents and the fund available.
What are possible causes of kidney failure?
Kidney failure can be caused by many sicknesses. In Emmanuelâ€™s case, it is caused by sickness called nephritic syndrome and this is for unknown reason. The kidney just gets damaged. It happens in children, what happens in nephritic syndrome is that the kidney starts leaking out a lot of protein in the urine instead of absorbing it, and the consequence is loss of protein in the body which leads to swelling of the body. After sometime, the kidney stops doing its work properly.
That is what happened with Emmanuel. It is one of those reasons the exact causes are not known but it is associated with factors like chronic malaria that we have in our environment.
In children, other reasons may be when they have infections of the kidney that are not properly treated. We donâ€™t just give any medicine for kidney infection; we have to go to hospital to get the right drugs and right doses, because when it is not properly treated, it can lead to kidney failure.
HIV infection is one of the diseases that is beginning to be one of the causes of kidney failure because HIV patients due to the anti-viral therapy are beginning to live longer, so we have seen cases of kidney failure in them as consequence of the infection itself. In adults these are the commonest causes. Drugs can also cause it just like in children.
Do we have the required medical personnel in Nigeria to handle the disease?
We have the capacity in Nigeria and we have the facilities to be able to look after those with chronic kidney disease that has been going on for a long time. Our limiting factor is that our patients come to hospital late, when 70% of their kidney has been damaged and at this point there is not much we can do, it becomes difficult to manage.
Transplantation is a different issue, there are many places in the country that are able to carry out kidney transplant successfully. Manpower resources and health facilities to look after kidney diseases are widespread all over the country.Â For kidney transplant, it has specialized centres. I have talked about St. Nicholas Hospital in Lagos and others, and they have done it very well. Also University Teaching Hospital Ibadan has plans to start a kidney transplant programme.
Can the disease be prevented?
Yes, it can be prevented, one of the other reasons why children have kidney problem is when they are born with abnormal kidney. You notice that some children when they are born are unable to pass urine. If our children when they are born have access to medical personnel who are able to detect this abnormality, they will pick them up early and treat them to prevent the infection from progressing to kidney failure.
It can be prevented by making sure that we donâ€™t give our children herbal concoctions that will damage the system. If any child has problem with passing out urine and the case is reported on time, it can be corrected before it progresses to kidney failure. Of course in adult, controlling hypertension and diabetics will go a long way in preventing kidney disease and HIV infection. It requires routine check up and discipline.
Any physical symptoms?
The commonest feature is swelling up and difficulty in passing out urine. Apart from that there no other physical symptom.
How much is required for Emmanuelâ€™s surgery?
About N8 million is required out to carry out the transplant. Right now Emmanuel has no kidney to live, his two kidneys are damaged. By the grace of God he is going to have new life, go back to school, play basketball because he is a tall boy. So we are appealing for assistance to enable this to be done and no amount is too small.