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Today, i will refrain from complaining about the myriads of problems bedeviling the healthcare provision in Nigeria. I will not complain about the fact that Joint Health Sector Union (JOHESU) has given the federal government 15days ultimatum to meet their demands or the fact that the National Association of Resident Doctors (NARD) also gave the government 21 days to meet their own demands. I will not complain about the attitudes of healthcare personnel to their patients or the unavailability of essential consumables to aid the healthcare worker do his work effectively.

Today is dedicated to the women, our mothers and wives, the good women of Nigeria who have played a role in our existence as humans. May The Almighty continually bless you all.


The essence of marriage to the average African is to bear offspring that will take after them when they are gone and look after them in their old age. In order to achieve this a man and a woman shall come together, with the man donating a spermatozoa and the woman donating an ovum (egg) which fuses to form a zygote which develops into the fetus which at term (9 months) is delivered. Normally delivery should be through spontaneous vaginal delivery but due to one reason or another may end up caeserean section.


All methods of delivery is associated with pains though to a varying degree. Spontaneous vaginal delivery still remains the commonest method of delivery which has been described to be as painful as a fracture. this pain has been noted to make some women detest the idea of going into labour spontaneously.


So why labor in pains in this 21th century? The good news today is that there are various methods of controlling pain in labour but the commonest is the EPIDURAL ANALGESIA IN LABOUR which will form the core of our discuss today.


In the US about 50% of the pregnant women make use of Epidurals, in Nigeria, it is sparingly used because the populace is not aware that it is available in most hospitals in Nigeria, also the skill and requisite manpower to monitor pregnant women with epidurals in labour is not adequate.

What we have noticed is that those who request for this are wives of doctors or healthcare workers. This ought not to be so.

Why subject our wives to immense pain and discomfort when there are alternatives with minimal discomfort.?

As you visit the obstetrician and prepare for labor, ask him/her about pains in labour and how it can be controlled. Ask about the choices you have or concerns about any form of analgesia they may want to use for you.


What is Epidural Analgesia?


This is a form of regional anaesthesia where pain impulses are blocked in a particular part of the body. It blocks nerve impulses from the lower segment of the spine and is associated with reduced sensation in the affected body part. A local Anaesthetic agent is often used for this alone or in combination with opioid analgesics to improve the block.


Who will benefit from an Epidural?


1. Every pregnant woman who requests it

2. A woman with Pregnancy Induced Hypertension or Pre-eclampsia

3. Conditions of prematurity or intra-uterine growth retardation

4. Conditions of Intra-uterine fetal death

5. Induction or augumentation of labour

6. Instrumental or caeserean delivery

7. Twin gestation

8. Presence of significant medical disease such as hypertension, diabetes or heart disease.


Epidurals are contraindicated in women with bleeding disorders, skin infections around the lower spinal segments or any systemic infection. A pregnant woman also reserves the right to refuse an epidural. Note that Epidurals are given when a woman enters the active phase of labour.


http://americanpregnancy.org/labor-and-birth/epidural/ explains the procedure in a clear and simple way below

How is an epidural given?

Intravenous (IV) fluids will be started before active labor begins and before the procedure of placing the epidural. You can expect to receive 1-2 liters of IV fluids throughout labor and delivery. An anesthesiologist (specialist in administering anesthesia), an obstetrician, or nurse-anesthetist will administer your epidural.

You will be asked to arch your back and remain still while lying on your left side or sitting up. This position is vital for preventing problems and increasing the epidural effectiveness.

An antiseptic solution will be used to wipe the waistline area of your mid-back to minimize the chance of infection. A small area on your back will be injected with a local anesthetic to numb it. A needle is then inserted into the numbed area surrounding the spinal cord in the lower back.

After that, a small tube or catheter is threaded through the needle into the epidural space. The needle is then carefully removed, leaving the catheter in place to provide medication either through periodic injections or by continuous infusion.The catheter is taped to the back to prevent it from slipping out.


When this is done, the Local anaesthetic agent will be injected through the catheter at intervals or through a continous infusion through a syringe pump or a patient controlled mechanism as when needed.


What are the benefits of an Epidural?

1. It improves the experience of labour

2. It reduces the discomfort associated with labour

3. it allows you the opportunity to participate actively in the process of childbirth

4. It can help you deal with exhaustion, irirtability and fatigue associated with labor.


What are the risks associated with Epidurals?

1. There maybe a sudden drop in blood pressure following this procedure, which will necessitate your blood pressure being measured regularly at intervals.

2. Some women experience severe headaches due to leakage of spinal fluid.

3. Numbness in the lower half of the body following delivery

4. Some side effects noted include nausea,urinary retention,shivering, backache, or soreness at the site where the needle is inserted.



In view of the above possible risks, it therefore implies that this procedure requires expertise to be successful and to avoid situations were the epidural is ineffective or a unilateral block to only one side of the body is achieved. So among the questions you must ask your obstetrician is the level of expertise of the person giving the epidural and adequacy of monitoring to both yourself and your baby.


Like i said earlier, epidural anaesthesia is available in Nigeria but most women dont request for this mainly because the awareness of its availability is not there. Every hospital with a trained anaesthetist should be able to offer this and note that you may need to pay a little bit more than the normal delivery fee.


I therefore encourage you to try this option as there are alternatives to experiencing pain in labour.


HAPPY MOTHERS DAY!!!


....kindly follow me @drscopey

RE-EMERGENCE OF LASSA FEVER IN NIGERIA:OFFICIAL PRESS RELEASE BY THE ASSOCIATION OF RESIDENT DOCTORS (ARD) FEDERAL MEDICAL CENTER LOKOJA 26/1/16.
The Association of Resident Doctors (ARD), Federal Medical Center, Lokoja is deeply worried by the reemergence of Lassa fever in Nigeria after the last outbreak in 2012 which claimed many lives.

The Federal Ministry of Health has revealed that Lassa Fever has claimed 63 lives out of 212 suspected cases reported from 62 local government areas in affected states. So far, not less than 17 states have been affected over the last 8 weeks, including Bauchi, Niger, Taraba, Kano, Rivers, Oyo, Ondo, Edo, Plateau, Gombe, Nasarawa, Lagos, Delta, Ekiti, Ebonyi, Zamfara and our dear Kogi.

That an ailment which originated in the country about 47 years could resurface, despite advancement in medicine, shows that Nigeria’s healthcare system is weak in disease prevention and control.

The death rate attributed to Lassa fever is currently put at 43.2 per cent, a rate considered very high by all standards.

Fact sheets released by the United States Centre for Disease Prevention and Control (CDC) indicate that Lassa virus, the most prevalent virus-induced hemorrhagic fever in Africa, is carried by rats and spread to humans through contact with urine or droppings of infected rats, causing devastating outbreaks similar to Ebola virus. In West Africa, the virus kills an estimated 30,000 to 40,000 people every year—approximately 10 to 15 percent of those infected.

The document explains that, in rare cases, the ailment could be spread from person to person through direct contact with a sick person’s blood or body fluids, but there is no record of transmission through casual contact.

The illness reportedly was discovered in 1969 when two missionary nurses died in Nigeria. The virus is thus named after Lassa, a village in Borno State in the North East where the first cases occurred.

The first case of the current outbreak was reported from Bauchi in November, 2015. This was followed by cases reported by Kano State, and subsequently the other states mentioned previously.

Lassa fever is an acute febrile illness, with bleeding and death in severe cases, caused by the Lassa fever virus with an incubation period of 6-21 days. About 80% of human infections are asymptomatic; the remaining cases have severe multi-system disease, where the virus affects several organs of the body, such as the liver, spleen and kidneys.

The onset of the disease is usually gradual, starting with fever, general weakness, and malaise followed by headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea, cough, and bleeding from mouth, nose, vagina or gastrointestinal tract, and low blood pressure.

The reservoir or host of the Lassa virus is the “multimammate rat” called Mastomys natalensis which has many breasts and lives in the bush and peri-residential areas. The virus is shed in the urine and droppings of the rats hence can be transmitted through direct contact, touching objects or eating food contaminated with these materials or through cuts or sores. Nosocomial transmission also occurs in health facilities where infection prevention and control practices are not observed. Person to person transmission also occurs most especially when a person comes in contact with the virus in the blood, tissue, secretions or excrements of an infected individual.

As we join hands with our parent body (NARD) to kick Lassa fever out of Nigeria once and for all, ARD wishes to reinstate its commitment to quality healthcare delivery in Kogi State. We also wish to assert the following:

(1) We commiserate with the families hit by Lassa fever in the country.

(2) We commend the Federal Ministry of Health for the prompt interventions to arrest further spread of the disease and for ensuring that Ribavirin, the specific antiviral drug for Lassa fever, is in good supply to most states of the federation.

(3) We urge governments at all levels, NGOs and health professionals to step up advocacy on Lassa fever to all stakeholders including market men and women, traders, food vendors and hawkers, etc such that they have sufficient knowledge on how to prevent rats from gaining access to food in stores and warehouses, especially uncooked food such as garri, groundnuts, biscuits, meat, fruits, etc which can easily be contaminated by rodents. There is an urgent need to intensify awareness creation on the signs and symptoms of the disease as well as general hygiene measures.

(4) We decry the inadequate state of facilities in FMC, Lokoja in the face of the ongoing epidemic that has ravaged neighbouring states, especially considering the fact that other institutions across the state (including health) are on temporary lock-down. This is not in tandem with the principle of universal health coverage which has to be accessible, available and affordable.

(5) We note with displeasure that our centre is not sufficiently equipped to deal with a suspected, probable or confirmed case of Lassa fever. There is no functional isolation unit, no visible personal protective apparatuses, and the entry points for patients in the hospital (GOPD, A & E, EPU) are at maximal risk.

(6) We lament the poor state of refuse disposal in the state, especially as these unhealthy sites serve as breeding grounds for the vectors (rats). Receptacles should be strategically located for ease of refuse and other waste disposal.

(7) Clinicians and relevant healthcare workers in the state need to be sensitized and mobilized in areas of patient management and care.

( We implore the management of FMC, Lokoja to take practical steps to ensure routine infection prevention and control measures, including provision of items noted in (5) above.

(9) Family members and health care workers are advised to always be careful to avoid contact with blood and body fluids while caring for sick persons.

(10) We call on the general public to ensure that persons presenting with any of the preliminary symptoms are taken to the nearest health facility for prompt medical attention.

(11) The public should ensure high standards of personal and environmental hygiene as well as avoid any exposure to rats.

(12) Since the Lassa Fever scourge has been linked with rats, the only logical way for residents in the state to ward off rats in their surroundings is to keep the environment clean and healthy.

We call on residents to properly maintain their soak-away and other channels which are very convenient spots for convergence by rats. Only such safe practices would guarantee a clean and healthy environment in the State as well as ward off the incursion of rats and other undesirable pets into homes and surroundings.

Long live ARD-FMC, Lokoja!

Long live NARD!

Long live Kogi State!

Long live the Federal Republic of Nigeria!

Signed:

Dr. Kennedy O. Obohwemu Dr. Nnanna U. Agwu
President Public Relations Officer

What about other vacation destinations in Nigeria... Obudu Ranch et al?

It's good for her...