This Week with Aniedobe: Death by Medical Mission

One of the things I enjoy in the village is going to Church, sitting way way at the back, and just enjoy the stories that time is telling.  Seated in front of me are generations before and after me. As I age, so does the generation before me age.  Seeing them, I see my tomorrow. I see all the things that time has done to them and I know that time will do same to me.  Someday, soon, my generation is going to look like the raggedly old men seated in front of me. Then we will all join our ancestors.
How slowly time drifts and yet in many ways everything stays the same. Papa NTony, now 77, once a dashing business man, is looking very much like Nwankwo, his Dad when we used to call Nwankwo, Papa Nnekwu.  I didn’t see the resemblance them, but as Papa NTony ages, he has been looking more and more like Nwankwo.
There are two things about Papa NTony that stand out in my mind. One is Mama NTony and the other is cement business.  Papa NTony used to hang out at Nkalagu Cement Factory where we grew up hustling for Cement allocations.  Wherever he went, though, Mama NTony went with him. I have never seen a more inseparable couple than the two of them.
So you can imagine how odd it struck me when I saw Mama NTony in Church and there was no Papa NTony.  After Church, I went straight to ask how Papa NTony was doing.
“He is not feeling well today. He is just weak all over and the Nurse asked him to rest.”
“In that case, why don’t you go straight home and I will meet you there in fifteen minutes time.”
If Papa NTony is not with Mama NTony, you didn’t need to be told that the situation was serious. I had to hurry.
At 77, you know that practically every Igboman is struggling with both Hypertension and Diabetes as co-morbidities.  Although not a Doctor, I have come to realize that many of our people have zero access to qualified Doctors and worse still, are so medically ignorant that sometimes they become their own worst enemy.  Since the era of medical missions whereby individuals and organizations at every level rush home to dispense medications to poor and ignorant folks back home, without adequate follow ups, the medical missions have in turn become a killer of sorts.
I quickly greeted other folks in Church who were waiting for me and I dashed home on foot to get my Sphygmomanometer, Stethescope, Thermometer, and my Glucose Meter and swung to Papa NTony’s house.
“Nna, inatalia?’ he appeared to have managed to speak in beating hurried breath. He was lying down, looking dazed and disoriented, and I could swear, barely conscious.  The man was alarmingly sick, but I did not want to alarm Mama NTony.
“Mama NTony, has he had anything to eat?”
“Not yet. He has diabetes and the nurse asked him not to be eating too early in the morning because of his blood sugar.”
“When did the nurse come to see her?”
“She came on her way to Church and said that what is happening to him is the same thing that happened to him one month ago and that she will bring drip and give to him and that with rest, he will be alright.”
“Are you talking about Caro, be Okwuaku who runs that Chemist store on the way to Ezi Elias?”
“Yes. She is a very kind nurse and she will do anything for Papa NTony. She said that her drip has finished and she will go to Awka to buy more and come and give to Papa NTony tomorrow.”
“Did she measure his blood pressure when she came?”
“No, she does not usually do that. Only doctors do that.”
“Has Caro ever measured his blood sugar?”
“Mbanu, she said that she will charge more if she begins to do that and that people who use that thing are people who come from America. She is the one who told Papa NTony to just use how many times he urinates to gauge his diabetes.”
“Does she even have a Stethescope – nyabu, this thing around my neck.”
“Nna, ibakwa nke ndi Amelica. She is not a Doctor now, so she can’t wear that thing.”
“Is he seeing any Medical Doctor?”
“No, just Caro. Papa NTony does not like spending money that he does not have on Doctors when he can use the money to buy medicine. Some of this medicine cost a lot, you know. Even the one they call Novaku (norvasc) that he used to treat high blood pressure, that one costs hundred Naira a tablet and we can only afford five tablets at a time. If not for people that come from Obodo Oyibo to give us free medication, Papa NTony would have died by now.  Chukwu gozi kwa Umu beanyi.”  
“Does he have any disease that you know of?”
“No, just hypertension and diabetes.  Also arthritis on both knees. But other that, we are managing just like any other old people.”
“How has his blood sugar been lately, is it under control?”
“It is good and very much under control. With prayer, God has cured Papa NTony of diabetes and he does not have to take the medicine all the time. Nwam, ekpele amaka. But if he begins to urinate a lot, that is when we know that his blood sugar has gone up and we take the medicines we got from umube anyi si obodo oyibo to make him to stop urinating all the time. Like last night, he was urinating a lot and he had to take his medications.”
“Does he have fever?”
“But he is sweating?”
“Ya, that one is new. Whenever he is this weak, he tends to sweat a lot and I try to encourage him to drink water.”
“How about his blood pressure?”
“God is also taking care of that for us too.  Papa NTony is alive today because of prayers. In fact, God has cured him. That is what the Brother said at the prayer house we go to. The only times he needs his medication is if he talks a lot or is upset and he begins to have headache. That is when we know that his blood pressure is up and then he will drink his medication from obodo oyibo and he will be fine.”
“Mama NTony,” I commanded, “Please go and bring me all the medications he is taking right now and bring all of them immediately.”
I swung into action.  First, I felt his pulse – good but very fast.  Then I used my Stethescope to listen to his heart beat. Fast. 97 beats per minute. I touched his forehead and felt the sweat beads. I was thinking adrenaline at that point. This man needs to be in an emergency room – but which one. Emergency room in the village, that is a good joke. Everyone is out listening to three hour sermons.  By the time he gets competent help, who knows what might happen.  I measured his blood pressure – 195/95.  So much for blood pressure under control. Then I measured his blood sugar. 58. The man was slipping into Diabetic Coma right in front of me and he was even told not to eat. Geez, where do they get these ikpo ngwo nurses from?
“Is there no other nurse you know?”
“There is UK, nwa ndi be Okolo, but she charges a lot.”
“Do you have her number,”
“Yes, but she charges too much.”
I called UK. She was there. I asked her if she had Dextrose drip. Positive.  I told her to bring it right away.  She said she had no car and she did not know where to find okada on Sunday morning.  I hopped into the car and came back in fifteen minutes with her. Papa Ntony was still barely conscious.
UK began to administer the drip and I asked her to advise me on the nearest emergency room where Papa NTony can see a Doctor before tomorrow morning.  She said she does not know unless we are willing to go to Nnewi Teaching Hospital – otherwise there is no guarantee that he can see a Doctor before tomorrow. That she is sure that any emergency room he goes to will just put him drip and give him antibiotics.
“Why antibiotics?”
“He appears to have a strong cough. If you give him antibiotics now, it will clear the whole cough.”
“But he doesn’t have fever?”
“Ya, but sometimes, the fever will be hiding inside the cough.”
Chineke. Why am I even wasting time talking to this ikpo ngwo nurse. Is it this bad?
Then I looked at the basket where Papa NTony puts his medications – holy smokes.  Every manner of drugs was in it. This was Pharmacopeia gone crazy.  There were bottles or cards of amlodipine, norvasc, Sular, felodipine, losartan, Cozaar, Diovan, Valsartan, Benicar, Accupril, Vasotec, atenolol, Metfomin, glucotrol, Amaryl, hydrochlorothiazide, Aspirin, Methylsalicylic acid, Procardia, glucophage, Paracetamol, Tylenol, Panadol, etc.”  Holy smokes, I kept thinking.
“Which ones did he take last night?”
“I don’t know but I think that it is this big white one (Metformin) and this one that is blue (glucophage). I think he also took one and half of this one (Amaryl).”
“Why one and half?”
“Because he doesn’t want it to finish.”
“How much of these does he take?”
“He takes enough to make him stop urinating all the time.”
“Which ones does he take for hypertension?”
“That one (diovan) and this one (amlodipine), but the one he likes most is this one – pointing to an empty card of norvasc – but it has finished. That is the one that costs N100 a tablet. Once he takes two, his headache will go down.”
“How about these other ones – pointing to the slew of blood pressure medication he has been collecting from different doctors?”
“I don’t know. If PapaNTony is not so tired, he will tell you how he drinks them. I think he drinks some of them for his cough as well. He tends to cough a lot during the rainy season.”
“Then this one (aspirin) and this one (acetylsalicylic acid) – he takes one each to help with his arthritis. He also takes this one from America (Tylenol) when he has fever. It is very good with fever.  The other one, Paracetamol, is good with pain ndi Okenye.”
“Mama NTony, where do you get all these medicines from?”
“Umu be anyi na Obodo Oyibo, including nwa be Odenku – that one that is married to a white woman – but Papa NTony has a nose for hunting down Ndi Obodo Oyibo na enye ogwu.  He even went to Ukpor one time to get medicine.”
“Mama NTony, did anybody tell you that amlodipine and norvasc are the same medince? Or that Tylenol and Paracetamol are the same? Or that Papa NTony may be the one killing himself by overdosing on Diabetes medication? Or that all these medications are for treating hypertension or diabetes and some of them act alike? Did anybody even tell you that he is not taking therapeutic doses of some of these medications?  And by the way, his blood pressure is definitely not under control. Who is this your Prayer brother that has become your Doctor as well.  When you go to see these people from Obodo Oyibo, do you even tell them what drugs you are on?”
“Nwa anyi, if you tell them, you may not get a lot. So Papa NTony just tells them that he is not on any drug so that they can give him a lot.”
“And how about the expired ones –why don’t you throw them away?”
“Mbanu, you can drink two of them and it will just be as good as one. Believe me, they all work.”
I looked at Papa NTony, he was sweating less. His heart beat was coming down. He was looking less pale. I knew that I had made a definite diagnosis of hypoglycemia induced by over medication.  His blood pressure was still dangerously high.
I offered to take away some of the drugs that had either expired or were duplicates by different names, Mama NTony refused.  I offered to take Papa NTony to the emergency room. She refused. She asked me to instead give her the money so that they will buy medication and eat instead of seeing a doctor since he was now feeling well.  She said that she wasn’t going to touch any of Papa NTony’s medication until he is feeling well enough.
Then I paid UK and requested for Mama NTony to bring Caro to my house in order to collect the money for the emergency room.  In that way, Caro will get a good tongue lashing from me when she comes. These poorly trained nurses so na ndi ana aya.
I had saved another life, made more dangerous by the good intentions of our people in Diaspora. The idea of rushing home to dispense medications with different pharmacopeias – British, America, Asian – name it – to old and poor people in the name of medical missions is dangerous.  Diabetes and Hypertension need careful calibration of medications and do require regular doctor monitoring otherwise, those drugs can kill in the hands of ignorant people.  However, well intentioned people are, it is dangerous to hand over these drugs directly to poor and uneducated people.  The so called medical missions as people are running it now is a health hazard if there is no way of providing clinical continuity.  In primary health matters, there is no better way than to work with local health providers to make sure that the continuity is there. But anyway, if you do medical mission, you can become a Chief, but that is a talk for another time.
Obviously Papa NTony had made a habit of driving himself to hypoglycemia and Caro, not knowing what she was doing, would bring him back to life – but the poorly trained nurse would have still given him dextrose drip if he had hyperglycemia.  Caro obviously does her job with zero appreciation of medicine or vital signs.  She has no glucose meter, no blood pressure monitor, no stethoscope, nothing. Chei!
When Gwongwolo is playing Doctor, you know that the situation is dire indeed. And we have a government? Chei. And so called Ministers for Health with Fellowships of this and that who do not understand that even the medical mission practices need to be regulated or else might turn out to be unintended weapons of death.


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