George Egbuchulam: why we must act now!

I write with tears in my eyes. I’m heartbroken, I weep for the future of my country if people like George Chimezirim Egbuchulam should be dying from curable medical conditions. I’m terribly disturbed because I’ve continued to see this kind of deaths since my days in medical school. While some may see it as an act of God, it is perhaps more traumatic for those of us who due to our professional training, know it ought not to happen. The question then is, why can’t we stop it?

A lot of times, determinants of health and outcomes of health conditions are not within the control of the medical personnel. The behavior of the people and the actions and/or inactions of the leadership of any society largely determine the state of health and life expectancy. In the case of George, the later is to blame.

Late George Egbuchulam

Over the last months, George, his family, friends and well-wishers, medical personnel at the University College Hospital (UCH), Ibadan and even folks like me that haven’t met him fought through prayers, fundraising, professional input, blogging, etc to save his life. How I wish death had spared George for the sake of the loved ones and what he stands to contribute to societal development, but it didn’t. What do we do now? The usual stuff: shed tears, blame health workers or UCH, observe one minute silence, fill condolence registers, do candle light procession, post nice words about George on our facebook and twitter timelines; and move on? No, George deserves better that. Nigerian youths deserve better! We must not allow this to repeat itself, but how do we stop it? Let me give a brief background about the medical condition that killed our beloved friend, George.

Chronic Renal Failure (CRF) is an abnormal condition when the kidney is no longer able to perform its functions optimally and it is usually caused by chronic kidney diseases (CKD).  Common causes of CKD in Nigeria include chronic glomerulonephritis, hypertension, diabetes, sickle cell, urinary tract obstruction, etc.  The functions of a normal kidney includes blood formation, maintaining calcium balance to make bones strong, removal of harmful metabolic waste products (like urea and creatinine), control of blood pressure, maintenance of potassium balance which enhances the activities of the heart and also regulates the pH of the blood. When the kidney fails, there will be low blood count (anemia), weak bones, accumulation of toxic substances in the body, high blood pressure, heart failure and increased acidity of the blood. All these do not occur at the same time but anyone that occurs progressively gets worse as the illness progresses with time. The goal of haemodialysis is to remove excess fluid and toxic metabolic products from the body. It is not and can never be as effective as the kidney will do it naturally. It has its own side effects too. It’s only a temporary measure and transplant ought to be done as quickly as possible. 
   

A cross-section of the human kidney

 

In the case of George, a scanned UCH radiological investigation request paper I found in google images suggests he had chronic glomerulonephritis (CGN). The functional unit of the kidney is the nephron. The part of the nephron responsible for filtration of harmful waste substances is the glomerulus.  CGN is the inflammation (swelling) of the glomerulus and it has various types; needless to bore you with their names. It appears to me that he was in Stage 3 renal failure around July 2012. There are some types of CGN that 80 to 90% of patients may progress to Stage 4 (end-stage) renal failure within 10 days to few weeks. If transplant is not done early enough, the body progressively gets weaker even with ongoing dialysis. It may get to a level that it may not be strong enough to even withstand and survive the transplant. This is the problem most people with this condition face in Nigeria.

Our health system unfortunately is in a condition where about 70% of expenditure is out-of-pocket in a society where about two-third live in poverty and half of the youths are unemployed. The disease does not understand that the money is not there, it continues to get worse if unattended to. Many countries including Rwanda have social health insurance covering this type of condition. If Nigeria had such, perhaps George might have had his transplant as early as July, and wouldn’t have had to be on dialysis until September when good-spirited Nigerians were able to raise adequate funds for the procedure. Perhaps we wouldn’t have lost him. Yes, he would have lived. I’m very upset, same way I was when I lost a 17year old patient who was the only child of her widowed mother; same way I was when a youth corps member with similar condition had to leave our care in hospital for prayers because of lack of funds only to return later in a worse condition and eventually died. Some got sponsorship from their state governments and went to India for transplant, but couldn't return alive; the funding came late. Too many cases!  I can still see their faces, they all shared their dreams and life ambitions with me but they are gone with those lofty dreams. I wept the days I lost them, it could have been me, and it could have been anyone else.

More so, one thing I’ve learnt from many change-makers is that they’re usually inspired by an unpleasant occurrence. I heard many of such accounts while watching the presentation of CNN Heroes recently. The Tunisian revolution was reportedly instigated by an unemployed youth who committed suicide.  My health advocacy activities since my undergraduate days at the University of Ibadan (UI) were also inspired by some ugly personal experiences and furthered strengthened by my professional experiences too.  We need a stronger health system in Nigeria to provide good quality, affordable and equitable health care. When I read Fisayo Soyombo’s piece on George in July, I decided to do an article on this blog to support the fundraising effort and draw attention to what people with such conditions go through. Like Fisayo, George would have been a very close friend if I had met him in person. They both share admirable and enviable qualities. Beyond that, my colleagues and I in HAPPYNigeria launched a #SaveAll campaign to demand that government begin a functional social health insurance scheme. We started an online petition and expected that thousands of Nigerian youth will rush to sign it, so far, less than 200 have signed it.

For the sake of George, we must insist that government takes the needful measures to make our health system stronger and also begin a universal health insurance for all Nigerians irrespective of socioeconomic status. We should do it with same vigour and enthusiasm demonstrated during the #SaveGeorge campaign. I have started it in HAPPYNigeria, feel free to join the #SaveAll campaign by signing the petition here. A youth ambassador like Nze Sylva Ifedigbo wrote about it here. You can do same – update your facebook wall, tweet, blog, and sing about it, use your respective organizations, organize peaceful rallies; send SMS, call or mail your legislators and governors; just do whatever you can.  

George had a very bright future. I and many others started just like him in UI with active participation in campus journalism and other extracurricular activities. Our development as a nation will reman stunted if we continue to lose people like George in similar circumstances. No one knows who would be next. For the love of George, for the love of us and for the love of Nigeria, let the youths take action to persuade the government to make Nigeria healthier. By so doing, George will be remembered for not only doing well in life but also that his death brought about lasting change that saved many lives. Let’s #SaveAll, Act Now!

May the soul of George Chimezirim Egbuchulam rest in the bosom of the lord, and may God strengthen his family to bear his painful demise, amen.

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