George and the fate of Nigerians with Chronic Kidney Failure

I was enjoying a long vacation in Lagos, Nigeria during my secondary/high school days in late 90’s when I watched the announcement on African Independent Television (AIT) calling on viewers to donate towards the “Save Steve Kadiri” Appeal Fund. Steve Kadiri was an ace broadcaster with Ray Power 100.5FM in Lagos. He was diagnosed with Chronic Kidney Failure and was undergoing hemodialysis while preparation for kidney transplant was ongoing. Prior to that time, I knew nothing about kidney disease. I imagined how serious the illness was to require kidney transplant that was to cost about five million naira (N5m) then. Steve’s colleagues in the media continued the announcement for months until he eventually had the transplant in 2001. When I heard that Steve had a successful transplant, I was excited that the moneys donated by good spirited Nigerians were not in vain. Although the transplanted kidney eventually developed another problem that claimed Steve’s life in 2009, the earlier intervention and love showered on him extended his life by at least ten years. 

I began to understand the plight of people with kidney failure during my clinical posting in Nephrology Unit of the University College Hospital, Ibadan while I was a medical student. Then, I observed that chronic kidney disease was debilitating and adversely alters the body systemic functions; I noted that the cost of hemodialysis was unaffordable and unsustainable for a middle-income earner/family and also that most of our patients were usually moved from the ward to the morgue. 

Three years later while working as a House Physician in Nigeria’s capital – Abuja, I also worked in the Nephrology unit for three months. During this time, I co-managed patients with a variety of kidney diseases and also monitored some of them during hemodialysis.  None of the aforementioned observations I made while in medical school had changed. Rather, I noticed that we had a lot of teenagers and young adults being admitted for chronic kidney failure. It also came to my consciousness that a significant portion of our patients were people of low or middle socioeconomic class. The experience was frustrating because the fate of majority of people with such diagnosis in Nigeria is usually heartbreaking.

What are the causes of kidney failure? Why would a young man have chronic renal failure? Why can’t dialysis cure kidney failure? Why is renal transplant the definitive treatment? Why is the treatment so expensive? Why is there a possibility of recurrence even after transplant? What is the government doing to raise awareness on prevention of kidney diseases? Does Nigerian government support the treatment of people with chronic kidney diseases? If “No”,  then why not?

The questions above could be one of those boggling the minds of many compatriots. I do not intend to provide the answers in this piece. Then why I’m I writing this article? 

 George Chimezirim Egbuchulam is another  compatriot diagnosed recently to have chronic renal failure. As I write, he is still undergoing conservative management and would benefit from renal replacement therapy (kidney transplant) if more good spirited people show him the kind of love that Steve Kadiri got. George is a very intelligent young man and has been full of life, doing great things and serves as a model to his younger colleagues. I’ve not met him in person but I’m not ignorant of his activities and positive impact he has been making as an undergraduate and now a graduate student of the University of Ibadan, my alma mater. It was not surprising that thousands of Nigerian youths have embarked on intense online advocacy to raise the eight million naira (N8m) for George’s renal transplant and associated postoperative expenditures. Already, over N2million has been reportedly raised but I do know the ongoing dialysis would continue to depreciate available resources.

But why should people with such conditions be allowed to bear the burden alone? The government of United States, as rich as the country is, takes over the treatment of people with chronic kidney disease under the Medicare insurance program. Would it be out of place if government of Nigeria designates a portion of our collective wealth to assist George and other people in his situation? Thankfully, Delta State government responded to the #SaveOke twitter campaign and supported his surgery for a chronic leg ulcer (most likely due to diabetes) in India; Oke is a young man in his 20’s. Must the government always wait such advocacy to respond? What about the likes of many patients I managed with similar conditions that lost their lives? Has life become that cheap?

While I use this medium to call on well-meaning Nigerians to come to the aid of George Chimezirim Egbuchulam, I strongly recommend that the federal/state governments create a fund to finance the treatment of people diagnosed with chronic renal failure and other chronic disorders that are very expensive to treat. Preventive measures should also be taken to reduce the incidence of renal pathologic conditions in the country. It’s traumatizing to imagine that George’s may have further complications should the surgery be delayed, God forbid!

Please let’s save George, kindly send your donations to any of his accounts:

GTBank – 0117968706; Fidelity Bank – 3020722444; Unity Bank - 0018310939

May God bless everyone who has made contributions towards the efforts to save George’s life very abundantly. 


Addendum:

I'm excited to disclose that over N5million has been reportedly raised for George, a kidney donor has been identified and the surgery would be done in the near future. 
I think it would be great if we channel similar energy used to canvass for the fund raising to carry out a strong advocacy for government to take over treatment of people diagnosed with chronic renal failure. This can be done through the platform of Health Advocacy & Promotion Partnership by Youths in Nigeria. (HAPPYNigeria). You may wish to follow @HAPPYNigeria on twitter.

My Vote for 'ObamaCare'

The Supreme Court of the United States recently upheld the Affordable Care Act (2010) referred to as 'ObamaCare' in unofficial quarters. I wish to share a policy analysis/position paper I presented in February 2012 at the University of Kentucky Graduate School. Kindly read and share your thoughts. 

Affordable Care Act good for American People

The United States has the highest expenditure on health among all countries of the world and this progressively increases every year. However, the country ranks 31^st on life expectancy and fares relatively worse on many health indices than many other developed nations. The cost  of healthcare in the U.S. has been increasing progressively, while family income and employment numbers have fallen or been stagnant.  In addition, health disparities appear to be widening along socioeconomic lines. According to a report by US Census Bureau, the number of uninsured Americans has been increasing over the last thirteen years and has worsened during  the recent economic recession. 
The report stated that the number of American people without insurance coverage in 2010 was September 2010 was made up mainly of young adults aged 19 to 25, and low income families with an annual household income of less than $25,000. Much of the declines in the rates of insured Americans can be attributed to the loss of employer-provided coverage, which fell amid sustained unemployment and as employers continued to cut back on benefits. The percentage of people who had health insurance through their employers fell to 55.3% in 2010 from 56.1% the year before, continuing a long downward trend (compared to 64.1% in 2000). Apart from other contributory environmental factors, the relative poor health indices were attributable to the situation as analyzed above. There was therefore a compelling need to address the situation and that, in my thinking, was what the Patient's Protection and Affordable Care Act 2010 intends to do. 

President Obama giving assent to ACA

 Health Reform Policy
Before the passage of the Patient Protection & Affordable Care Act (ACA) in March 2010, a couple of futile attempts were made in the past to reform the American health sector through legislative policies; the last being President Clinton's proposed reform which failed to scale through in the Congress. Here are the implications of this policy on various age groups, when fully implemented. 

• Retirees on Medicare: Expansion of primary care by increasing Medicare payments to doctors in Family Medicine; Reduction in the cost of pharmaceutical medications; Encourages development of protective services for the elderly. 
• Young Adults: Can be kept on family insurance plans till age of 26; Can qualify for Medicaid if annual income is $14,444 or less
• Middle Class: More affordable and fairer insurance markets; Improved access to essential medical services in family medicine, pediatrics care and community medicine. 
• High Socioeconomic Class: Increased taxation for families making more than $250,000 per year. 

This policy when  fully implemented will guarantee near universal health care insurance for all American people. 

 The Case against the Policy

Final judicial pronouncement is being awaited on this policy following a suit by 26 states opposed to it seeking its nullification on the following grounds:

-          That it violates the right of an individual to choose whether to have health insurance or not.

-          That it violated the 10^th Amendment to the United States Constitution

-          That the requirement for state-level health insurance exchanges and expansion of Medicaid is an encroachment on the sovereignty of the states

In addition to the above legal challenge, a section of people believe the policy would increase the country’s deficit and harm  the economy.

My Position

From the public health perspective, I support this policy based on the fact that it will promote near universal health insurance for all American people. It will reduce health disparities and improve quality of healthcare received by people of different socioeconomic status. Given that the burden of ill health falls predominantly on those with low socioeconomic status who can often not afford care, making health care more affordable could improve the health indices of the U.S. in the near future. In addition, increasing access to  family medicine, pediatrics and screening services would lead to early detection and treatment of many non-communicable diseases and improve outcomes.
Without prejudice to the pending decision of the Supreme Court on this matter, I do not agree that ACA violates the rights of individuals; rather, I feel it guarantees the rights of individuals to affordable and proper health care which could mean right to life. 

Conclusion
While supporters and opponents of ACA may have legitimate arguments, the fact that the United States of America lags behind most other industrialized nations in health status and access to affordable healthcare insurance by citizens is indisputable. ACA has had an almost immediate positive impact on healthcare in US, by mechanisms such as providing tax credits for small businesses offering insurance to their employees as well as improve coverage for seniors. My final submission is that ACA has become, and hopefully will continue to be a positive force for improving the health of American people, and should remain in existence.