This is an age-old disease, but it is still very common in various communities
around the country. Often, it is treated with levity and disaster strikes with the
twin burden of avoidable tragedy and loss. Till today, it is very common in
many parts of Africa and many other developing countries in Latin America and
Asia. It is commonly found in the farms and gardens in those parts of the
world. The offending organism is a small bacterium that lives in the soil and in
manure known as Clostridium tetani. This bacterium enters the body from
wounds small and large and begins to produce a toxin from its cell wall that
causes so many of the scary features that characterise this infection.
The toxin is called tetanospamin and it is transported through the blood stream
to the various parts of the body where it exerts its effects on nerve endings to
cause some of the major features that are known to be associated with this
disease. Typically, these signs are more prominent when the injury is closer to
the head and neck region than in the lower limbs for example. The features are
less severe when the period between the injury and the onset of the very first
sign is more than a week.
Tetanus is no respecter of person or status, as it has been the cause of death
of both prominent and ordinary folks in Nigeria. This is in spite of the efforts
made in the last 40 years to actively immunise children and pregnant woman
with the anti-tetanus prophylaxis. However, if the dose of the bacteria with
which a person is infected is large enough, the duration of the infection is
irrelevant as the effects are still severe.
The common wounds that are prone to transmitting this infection are:
1) Cuts on the farmland to the hands and feet.
2) Injuries at home from used razors.
3) Incisions on the body made with razors and knives, a common practice in
many traditional communities
4) Ritual circumcision practices
5) Dressing of wounds with unclean materials such as warm soil.
6) The habit of cleaning the ears with materials often picked up from the floor
or ground
7) Wounds on any part of the body sustained in open drains and gutters
Scrapes and scratches made by domestic animals kept at home as pets.
Prevention of the sequel of events that can lead to tetanus must be the focus
in any of the situations mentioned above. Wounds sustained in any of the
above circumstances must be taken to the hospital where they are properly
cleansed and dressed, and the person involved placed on antibiotics to kill off
all remaining bacteria in the wound.
The dressing will also need to be changed on a daily basis while the wound is
fresh. But sometimes, when the wound is adjudged as large and serious
enough, such victims are admitted in hospital for proper wound care that may
involve repeated operations at short intervals in order to control any infection.
These operations are known as debridement. It is a serious affair and can avail
much when done properly in a good setting. The dressing is done by skilled
nurses wearing the appropriate kits. It is not true that the infection can be
transferred from one person to another through sweat, blood or wet clothes.
Such persons are also given a shot of Tetanus toxoid which does not become
active until after a few days. To complete the immediate treatment, a dose of
anti-Tetanus serum must also be given after a test dose. A test dose is
important because the injection is a foreign protein to which some people can
react very adversely. This serum kicks into protective action immediately.
For those persons whose wounds are caused by the traditional village surgeon
who performs the circumcisions with unclean equipment; for the medicine man
who treats every fever with incantations and the cutting of the skin with
scarification marks; for the family priest who makes incisions on the forehead
or the wrists and feet of the new family members, there is no hospital visit to
clean such wounds because they are not assumed to have been injured in the
real sense of the word. They have only, perhaps, been ‘branded.’ These are the
people for whom we must weep because they will arrive in the hospital late and
with the florid features of tetanus already well established in their system. For
people like these, agonising death is the usual result.
The effects of tetanus are very profound. They start in a little way and progress
fairly dramatically to a crescendo of effects, none of which is pleasant.
Frequently, death occurs. At other times, some people are saved with the right
combination of drug treatment and early recognition of the problem. These
features are;
1) Lock jaw
2) A sardonic smile that is actually a grimace
3) A stiff neck
4) An arched back
5) Muscle spasms which can be provoked by bright light; by noise; by any
form of disturbance you can imagine in the very severe cases.
6) A malfunctioning heart with an abnormal beat.
7) Cardiac arrest
Death.
The treatment of this disease has to be in a hospital setting with adequate
sedation, intravenous fluids and antibiotics. There must be as little disturbance
as possible. The room may be kept in shaded lighting with the patient alone
and minimum disturbance from injections and other similar medications. Those
who begin to show any kind of abnormalities in their heart beat should ideally
be treated in an intensive care unit where their breathing is taken over by
machines and the patient is placed in a medically-induced coma. This affords
such patients the opportunity to have intensive monitoring and the chance to
have adequate organ support so that they can have any hope of recovery. In
many cases, despite the deployment of the hardware mentioned above and the
availability of the kind of personnel relevant to their care, death still results.
This is one more example of the age-old saying that prevention is better than
cure. In the case of tetanus, it is also cheaper than cure. The vaccine is readily
available and may cost no more than a few hundred nairas in most hospitals.
On the other hand, treatment in an intensive care unit would run into hundreds
of thousands of naira with an uncertain outcome. Clearly, such an outlay of
financial resources is beyond the reach of most Nigerians or for most of the
people who live in the Third World. It is thus a curse whose worst effects are
preventable by immunisation. In our personal attitude to injuries, no matter how
trivial they may seem, there is much to gain by doing what is prudent. Allow a
trained person assess the wound and help you determine what has to be done.
It is not a question of waiting to see what might happen but by taking the initial
step to forestalling what could be a disaster.
Finally, the determination of what antibiotic to use by the patient should be by
the doctor based on his assessment of the wound. It is not a matter for the
local chemist to handle. Often, when complications have arisen, these same
people are likely to label it as a spiritual attack. Let us therefore, be wise and
learn to treat our wounds with care. The ones sustained at home from the clean
utensils in our possession are largely free of this risk because they are not in
contact with soil or manure or similar compounds that may make such a
complication as Tetanus a likely event.