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Why Yar’Adua’s recovery is slow

*Yar'Adua

* Kidney ailment might have complicated the disease
* More people die from heart diseases due to poverty

By Chioma Gabriel, Deputy Editor

Professor Martin Anthony  Aghaji  is  currently the President of  Nigeria Cardiac Society. He studied in  England where he distinguished himself by acquiring the Fellowships of the Royal Colleges of Surgeons of England, Glasgow and Edinburgh by examination. He also won the Master of Science Degree in Nuclear Medicine from Kings College Hospital of the University of  London in 1983 after undergoing the requisite training. He was a substantive Registrar in the professorial unit of Adult Cardiothoracic Surgery at Kings College Hospital Demark Hill London. He proceeded hence to the USA where he acquired a Fellowship in Congenital Heart Surgery, from the Milwaukee Children’s Hospital, of University of Wisconsin USA.
He specialized in Adult and Pediatric Heart Surgery, Thoracic Surgery, Liver Surgery, Kidney Transplantation and Nuclear Medicine.
In the area of open heart surgery, Professor Aghaji has studied extensively the complex methods and worked on simplifying these, such that they could  be adopted in an undeveloped country like Nigeria. The preference for materials like artificial heart valves and vascular grafts which are best suited for a developing economy, were studied and characterized.
In the area of esophageal obstructions, Professor Aghaji has pioneered the art of esophageal transplants both in adults and children. His research work has been recognized internationally that he co-chaired (with USA renowned Dr. Thomas R De Meester), the international symposium on “current controversies in the therapy of Esophageal Diseases” at the 6th World Congress of the International Society of Cardiothoracic Surgeons held in Hiroshima Japan in 1996.
He returned to Nigeria in 1986, where he has continued to work in the field of open heart surgery and cardiovascular surgery. In the field of open heart surgery, he is the first in Nigeria, to successfully replace the mitral valve (1986), first to replace the aortic valve (1987) , first to perform total correction of teratology of Fallot—the difficult blue-baby syndrome, and double valve replacement (1992). He has continued to maintain the open and close Heart Surgical programme in Nigeria despite all odds. He has successfully trained over 20 cardiothoracic surgeons from different parts of the country and African sub region-from Egypt, Ghana, Ondo, Kwara, Edo, Nassarawa, Cross River, Rivers, Enugu and Anambra States.
It  is perhaps in recognition of this contribution to the field of  open heart surgery in Nigeria, that the Federal Government designated UNTH a National Centre of  Excellence for Cardiothoracic Surgery in 1987.
In this encounter, Professor Aghaji answers questions on why there is increased cases of hypertension, cardiovascular diseases, kidney ailments and low life span for Nigerians. He also answers questions on why President Yar ‘Adua’s healing is slow  even when experts have said that  Pericarditis is treatable and common even here in Nigeria.

Excerpts.

What has been your experience in the field of practice of cardiology?
It is still a poorly recognised field. Many patients don’t even know that they have cardiovascular problems. Secondly, many of the patients cannot even afford treatment for their cardiovascular diseases on long term basis because mostly, the treatment is for life. Then, there is this issue of  fake drugs which is  long overdue for us to discuss.
Now, on the issue of surgical treatment, only few people could afford it locally. But that is the cheapest way to do it. Heart surgery is cheaper here than anywhere else in the world but  even this  low cost is too much for most of these  patients. So, in a quick summary, cardiovascular diseases have taken a lot of  tolls on patients. These days, we’d discover that a lot of people are traveling abroad for treatment and 95 per cent of  the people are cardiovascular patients or people who have  kidney diseases, heart diseases or stroke. Amongst those who stay back in Nigeria  to treat the disease, many cannot afford the treatment and so many die.

Why is the treatment  not affordable and many professionals unable to handle cardiovascular diseases here?
There are a lot of people, professionals back here who can tackle the disease but the organizational structure has made it difficult and that is what the Nigerian Cardiac Society is trying to address right now in terms of putting centres  for the treatment of these diseases  in  key places, example Abuja because it’s more central.

It seems these diseases are on the increase in the recent times. Why?
Well, you are right to say they are on the increase because the commonest heart disease in Nigeria is caused by long term hypertension diagnosed or undiagnosed. So, we find out that the increase is as a result of tension, stress and difficulties people go through and many patients become hypertensive at a very young age. And because people become hypertensive at a very young age, it is not diagnosed properly and then, before they get to the age of forty or even early thirties, they have all the complications.

Hypertension affects three main organs in your body: the brain, the heart and the kidney and this can cause stroke, heart failure and kidney failure which is probably one of the worst diseases people suffer from because of the heart and  the high cost of treatment.

Hypertension is a non-communicable disease but it’s  brought about by  life-style changes in the sense that we don’t exercise the way we used to do. You see a lot of people, they move from their air-conditioned homes into their chauffeur-driven air conditioned cars, to their air-conditioned offices and the same way, they go back home. There is absolutely no exercise and these things are important.

Sometimes, we need to walk, run, jog, go to the gym, work-up our bodies. Exercises help a lot. And three things are very important when it comes to hypertension and these people should know. One is , if your parents are hypertensive, you will likely develop hypertension because it could be in your gene. Then, what you eat also counts. If you take a lot of alcohol or smoke, it would increase your chances of developing hypertension or heart disease. So, what you inherited from your parents, what you eat or whether you exercise or not, come into play when it comes to developing heart diseases in Nigeria. When you go to major cities of the world, you find out that there are a lot of  these fast food joints and a lot of people feed from these joints from morning till night. They consume these fast foods at the detriment of their health and before they know it, they have developed heart diseases. You’d find out that by the time they are in their twenties, some already have heart diseases  which build up to a crescendo as they grow older.

In other words, our lifestyle is contributory to the development of heart diseases?
Our lifestyle is important, in terms of what you eat and whether you exercise or not. But like I said, other things are also important like what you inherited from your parents, the genes you got from them which could be in your system and you will not know. There are genes you will have and that will bring high uric acid level to your system.

Some doctors prescribe daily intake of aspirin as a way of curbing the incidence of hypertension and heart diseases. What exactly does aspirin do to the system?
A lot of my patients are on aspirin. It helps a lot. But there are some problems with aspirin also that you must really look out for because aspirin is not good for every one. What we usually do is give aspirin for while to know if a patient  reacts  to it or not and that is not all. Aspirin is just an aspect of it. There are other things you must do. Aspirin does not answer all the questions. It helps to prevent your blood from clotting and that could be at the last stage of  the situation getting bad.

You mentioned something about continuing medical education. Is it that some doctors in the field don’t update on what they know already?
Continuing medical education is a must for all doctors all over the world. In Nigeria today, you need to show that you have some form of education while you are practicing. The Nigeria Medical Council insists on that. I was the Chairman of Nigerian Continuous Medical Education and you need to show you have a form of  education while you are practicing and that is done yearly. You must produce your evidence or you will lose your license to practice medicine.

•Professor Martin Anthony Aghaji

Is that still operational?

Yes. The Nigerian Medical Council is still doing  it. You must show evidence that you  have attended some seminars, some teachings or some programmes while already in practice every year and CME is one way of doing that. I must say that another way is to discuss wherever you  are your experience with the kind of patients you have had: the ones you had problems with, the ones you had complications with, the ones you couldn’t handle or the ones that didn’t make it.

You see, things are really changing. On the internet, you can get links to major centres all over the world and you can get an update on medical treatment and discuss your problems with them in your patients’ management.
In Nigeria, it seems doctors are regularly breaking  their golden rule by abandoning patients to die in their quest to solicit for better conditions of service. They go on strike, forgetting that their number one call is to save lives.
The scenario you just mentioned is very worrying and there is no doubt nobody would support that aspect in the practice of medicine. The number one thing for doctors is to save lives, not to make them go the other way. But having said that, you are looking at a failed or failing system. It shouldn’t come to that. These doctors and patients are part of the system we operate in this country. You can imagine sometimes, we don’t have power overnight. Some doctors find it difficult to operate because of system’s decay.

The cost of this decay is that some doctors leave the country to go and practice in other parts of the world and after practicing abroad, no doctor would want to come back and practice here. The system must work for doctors to effectively do their jobs. It is the same systems’ failure that make people to seek medical treatment abroad for ailments that could be treated here in Nigeria. If politicians could make the system here to work, then you can impose sanctions on those who go abroad for medical treatment or who take their children abroad for education. A politician must make the system work to take care of him and the electorates. We didn’t elect him to jump the next plane and go out for treatment abroad for a treatment that could be done here and then you allow others to suffer here because of the way the system has been mismanaged. Here, we are dealing with a NEPA system that is not working. There is a general system decay and it is affecting all the major institutions. I am looking forward to a system that is very functional and then we can say that no politician can go for treatment abroad or send their children abroad for education. I’m looking forward to a system that is so perfect that if a politician sends his children abroad to study, he stands disqualified to contest elections.

We know that leadership in our country is poor and we have a more terrible follower ship. As a matter of fact, we have more problems with follower ship. We don\t exercise patience. We look at things from points of view of ethnicity and religion. That is not the way to do things. So, the point I’m making is that we need to revert the way we run the system and make sure that the politicians we put in place are the ones that have the interest of the country at heart and can take care of the electorate and their children and create a platform for quality education for them in Nigeria. If a politician should take his children abroad for education or if he goes abroad for medical treatment, he should be disqualified.

If you remember President Boris Yeltsin of Russia, he had an open-heart surgery. He could have gone to doctors in California or Connecticut or somewhere in the United States. But no. He garnered all the equipments needed for the surgery and took them to Russia and brought all the professionals to Moscow to perform the surgery in his country. That centre in Moscow is still performing heart surgeries today because all the equipments are there.

By that singular thing Yeltsin did, Moscow is a rated heart surgery centre in the world because of the availability of equipments. Now, Nigerians go everywhere in the world for heart surgery including Egypt and Ghana but we don’t want to develop our facilities here. The other day, we went to Egypt on medical tourism conference and only four of us in the plane carrying over four hundred people were normal people. The rest have cardiovascular diseases. So, we go everywhere. Egypt, India, South Africa, Germany, United States and even our Ghana. You can imagine the number of people that leave this country for treatment abroad and most of them are sponsored by the government. We need to encourage the treatment of these diseases here in Nigeria. Nigeria can boast of the best medical manpower all over the world. All they need is improved facilities: improved energy, water supply, improved security, power supply and then control the issue of  fake drugs.

How do we combat incessant strikes by medical practitioners?
As you know, strikes are caused by different problems. There are strikes by doctors, strikes by nurses and strikes by other medical workers. The organisational structure is faulty. The strikes may continue but I believe that when the workers are well attended to and their needs addressed, all these strikes will reduce. And what do workers want?

Workers want to be paid. Workers want to live in good environment. Workers want to have a good condition of service. These are the basic things workers are remunerated with all over the world. And if it is done like that in our country, the strike level would reduce.

What should be done to curb the circulation of fake drugs in the markets?
Fake drugs is one of the greatest killers in the society and NAFDAC was really doing its best to reduce it. When Dora Akunyili was the Director-General of NAFDAC, she did extremely well. She has moved on and a new person is there. I believe they are trying all they can. The issue is that we must have a work plan on  how to curb the menace. We have come to realise that drugs produced locally by regulated companies are more genuine than some of  imported drugs. I trust locally manufactured drugs because they are being produced under stringent conditions. These days, drugs brought from India, China and other places flood our markets. Consumption of  fake drugs is worse than armed robbery.

Innocent people, little babies die from the consumption of  these drugs. We should do  more than we are doing at present over fake drugs. Our regulations must be stiffer. We should clamp down on certain drugs importations. We should be vigilant about imported drugs. I’m aware Lagos State is doing more on the issue of curbing fake drugs production and importation. Lagos state exercises control over drugs being brought into the state. It works hand in hand with NAFDAC and if other states get as serious as Lagos in controlling drugs that come into the state, the issue of fake drugs would be minimised.  Another thing here are the institutions working on these. Our institutions are very weak and even where there are genuine intentions, the institutions we have in place are weak and that is the major problem with our country. We need to have institutions that are strong. We need laws that would punish fake drug importers or producers. Really, to curb the incidence of fake drugs, we don’t need powerful people, we need powerful institutions. In Nigeria, we operate with powerful people but weak institutions. That should not be so. We need laws that must punish offenders.

Is there any statistics on people infected with heart diseases in Nigeria?
It is known that six out of every hundred persons are born with some  sort of cardiac problem. But many of them can correct and only one or two cases could degenerate out of  these six. The cases of those who acquire it  later in life vary. Some get better and some depreciate depending on what I told you initially, as in what you inherited, what you eat and whether you exercise. Then, if you are a diabetic, you have more problems in your hands when it comes to acquired  heart diseases. I can tell you that noncommunicable diseases like hypertension, heart failure, kidney failure, stroke will outnumber all infectious diseases in this continent. We must know how to handle that.

Nigeria does not  keep statistics but UNDP, usually gives reports. What I can tell you for sure is that these non-communicable diseases are on the increase and we must do something about that.

Recently, former Kano State Governor, Abubakar Rimi died from shock as a result of  armed robbery attack. What manner of  heart problem would cause such a shock?
Why I cannot comment on it is because I didn’t see him while he was alive and sick. One has to know exactly what he had before he had that shock. It is very unusual for a politician of that calibre who has seen tougher situations in the State House in the country die from shock from armed robbery attack. It is very difficult to comprehend. But having said that, I would say that if one has a heart disease and experiences shock, like loss of a spouse, loss of a child or a loved one, or that something happens to him , he can have a heart attack. People have heart attacks  whether they have documented or undocumented cases of  heart diseases.

In the book we are writing right now, we stated clearly that heart diseases can cause heart attack, whether the heart disease is known before or not. Remember they say hypertension is a silent killer because it doesn’t give  signs, it just kills. So, whether the disease is documented or not, it can cause heart attack or death. A few weeks ago, an honourable senator just had heart attack and died. This is worrying. Sometimes, it shows signs and you see people running to India, Germany, South Africa for treatment. Sometimes, you may have the money but not the time.

So, the cardiac society is trying to see whether the government with our partnership can set up an Acute Emergency hospital because we need to have a centre that can sustain our lives when incidents of  heart attacks or heart failure arise.

When President Yar’Adua had pericarditis, the doctors said it is treatable here in Nigeria. Why is it taking him such a long time to recover?
Again, it is difficult to make comments on something I did not see. But I can tell you pericarditis is a common disease. I’m having an  operation on Friday (yesterday). I operate on Wednesdays and Fridays. It is not a very serious disease in the sense that it could be easily treated.

However, what might have happened in  the  case  of  the man  you have mentioned is his medical history. You know he has been traveling overseas due to a kidney problem. And one of the problems of  kidney disease is that it could cause pericarditis and when it happens that way, it is not straight forward to treat because you need to get the kidneys right. If you don’t get the kidney problem corrected, it could be difficult . You must get the kidney problem corrected so as to treat the heart.

Now, talking about inter-professional squabbles, doctors thought Dora Akunyili was a going to be made the Health Minister and kicked against that. Why? She is a Pharmacist.

Inter-professionals squabbles in the medical field is something that has been there and it is just a show of some frustration. It’s a way people vent their anger at the system. For example, people who behave in ethnic fashion would want their ethnic interests in the choice of who becomes who. Some of these people are not protecting any profession per se. In terms of personal satisfaction, you’d find that many people are not happy in the medical field because of  the case going on there. For instance, let me take you out on the current exco. You have somebody who read, lets say  Physics and got a Masters. Then, you have somebody who did History with a B.A. and goes ahead to get a Masters in History and Religious Knowledge.

The system made it that someone who read Physics earns more and the person who had 2-1 earns more. You find out that the British that set up the system made it in such a way that the person who did Physics with 2-1 earns more than the person who did History. So three things are important  when it comes to what you earn: one is your qualification and how well you passed, secondly, how you work.

For instance, when I was doing my Housemanship in the United States, I chose to be on call everyday and I earned more than  my colleagues who were on  call once in two days. In a day, I  had two nurses. One would come in the morning by 8 am and stayed in the clinic. By 4 p.m she would go home. Such a nurse should not earn as much as an ICU nurse who would come at night and stay awake all night. The fact that you worked night is a reason to earn more than the nurse that  just comes in the morning and leaves in the afternoon. So, if we are serious, we should address all these and know what each person contributes to the system. If people work harder and earn more, all these squabbles won’t be there. And these issues shouldn’t be  in the first place.

What’s your view on the use of herbal medicine?
All drugs we use are produced from herbs. But the difference is that what we use as tablets or capsules have been purified and are produced pharmaceutically. And they have undergone the appropriate test in animals first before being administered on human beings.

But you cannot say same for herbal drugs. You don’t know how pure it is, you don’t know the circumstances under which they are produced. And some of  them are concocted anywhere and therefore cannot be the same with the ones that are produced pharmaceutically and clinically. Secondly, herbal drugs have no documentation. Herbal medicines are cheap but cheap things are not usually the best.

In our practice, we now know that herbal medicine can now cause more problems for our patients and if you take it with other drugs, there is what is called drug interaction and the patient is in trouble because you don’t know how the drugs interact. So, it is safer for patients to take drugs that have been purified and follow the drugs regulations. It is safer and controllable than taking herbal medicine that have no regulations and are not produced pharmaceutically.


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