Lead Poisoning: Bagega and the Failure of Leadership

Last week the media was agog with a news report titled “Saraki commends Jonathan’s intervention in Zamfara village”. When I read this title on twitter, I quickly clicked on the link with excitement to read the details. I thought the reason for the commendation could be that the problem of lead poisoning which has reportedly claimed the lives of more than 400 children in Zamfara State has probably become a thing of the past. I was completely wrong. The Chairman of the Senate Committee on Environment, Dr Abubakar Bukola Saraki was commending Mr. President for his “approval to release promised funds for the remediation of Bagega Community in Zamfara State”. My excitement immediately turned to strong feeling of disappointment. I feel you may want to know why, please read on.

In March 2010, an unprecedented epidemic of lead poisoning was discovered in Zamfara State. This was a consequence of the activities of local gold miners in the affected communities.  Although there has been gold mining in Zamfara for decades, the substantial appreciation in the price of gold since 2009 led to an upsurge in artisanal mining activity. Local miners dig up rocks by hand, breaks them into pebbles with hammers, grinds the pebbles to sand with flour mills, and extracts gold from the sand using sluicing, panning, and mercury amalgamation (and in some cases, cyanidation). Usually the health problems associated with artisanal mining are related to mercury and/or cyanide use. However, in Zamfara, gold bearing deposits contain unusually problematic concentrations of lead. Consequently, the environment has become terribly polluted, so much so that the CDC described the epidemic as the worst in modern history. This has resulted to the devastating effects of lead poisoning especially among children and pregnant women in the community. The worst hit community at this time is Bagega.

 

An international organization, Medecins Sans Frontieres (MSF) also known as Doctors without Borders has been on ground since the discovery of this tragic epidemic helping to treat people affected particularly children. According to its recent report, MSF has enrolled more than 2500 children in her treatment programme; 2000 were still on treatment, 500 on follow up while 300 had been discharged at the time of the report.  Lead poisoning affects both children and adults but children have more risk of exposure (closer to the ground, crawl and play often) and the effects on them are more catastrophic. Lead poisoning may cause a lower intelligence quotient (IQ), behavioral problems, stunted growth, chronic anemia, deafness or chronic kidney disease/failure. Lead poisoning rarely shows any sign or symptom until the exposed person becomes very sick.   Some scientific studies have documented a correlation between lead exposure among women and higher rate of miscarriage, premature deliveries, stillbirth and congenital malformations. But is treatment of identified cases as MSF is doing enough? Absolutely not! Chelation therapy without remediation is like using basket to fetch water.

 

More so, mining of natural resources is in the Exclusive List of the 1999 Constitution (as amended). Therefore, the federal government bears the responsibility of controlling the activities of the miners and protecting the environment from pollution that may arise from those activities. So it won’t be out of place to say that the lead poisoning epidemic is a sign of governance failure. One would have expected any responsible government to react swiftly and stop illegal mining in Zamfara, train the local practitioners on better and safer techniques to maintain a healthy environment without denying the local miners their source of economic sustainability. A responsible government would also embark on immediate remediation of the affected communities and treatment of identified cases. 

 

How did the federal government respond? An Inter-Ministerial Committee on Lead Poisoning was inaugurated by the Presidency in 2010. What did the committee achieve? Nothing! In May 2012, the federal government convened an International Conference on Lead Poisoning in Abuja during which President Jonathan reportedly pledged a release of N850 million to clean up the affected communities. Sadly, none of the 7 action points unanimously agreed at the conference has been fully achieved 8 months after.  According to MSF report, the technical sub-committee of the Inter-Ministerial Committee visited Zamfara in mid-October 2012 (more than 2years after the discovery of the crisis) for an assessment and also met with stakeholders. Expectedly, the visit was widely publicized; the Federal Ministry of Information wrote a story on its website titled, “Lead poisoning: Proper management system stepped up in Zamfara State”.  What happened thereafter? Absolutely Nothing! There has been ongoing advocacy by MSF, Human Rights Watch and local civil society groups. Not even the action of Nigerians who besieged Mr. President’s facebook page last year to express their frustration with his inaction was enough to spur government to expedient action. 

 

I’m not unaware of the efforts of Senator Saraki’s committee to draw attention to the situation; I’ve personally read his tweets on that. But I find it difficult to understand why he should be commending the President for “approving” money to solve a problem that has claimed the lives of more than 400 children and left many others with permanent disabilities almost 3years after the discovery of the crisis. As usual, the federal government will have their explanation but none will be acceptable for this horrendous display of leadership ineptitude and crass insensitivity, to say the least. The government of Zamfara State that kept waiting ‘forever’ for the federal government’s intervention when it could have mobilized funds, saved her children and the environment and apply for refund from the federal government isn’t better either. For how long would Nigerians continue to suffer from anemic and marasmic leadership especially when it concerns health matters? Action is long overdue; Save Bagega!!!

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How Fever Kills our Children in Nigeria

Yes please, you read it correctly, fever. But does fever kill? Can it really cause death? Of course it can, particularly among children less than 5years. Nigeria has retained her unenviable record as one of the countries with the highest cases of childhood death globally. I used to think the figures were being inflated. However, from my experience as a physician and public health practitioner, I feel the magnitude is likely underestimated; no thanks to our poor data management system.   

Is fever a disease, of course not, it is actually a common symptom of many childhood killer diseases in Nigeria. Fever is defined as body temperature of more than 37.4 degrees Celsius. The common childhood killer diseases that present with fever in Nigeria include malaria, pneumonia, measles, HIV/AIDS, otitis media, meningitis, tuberculosis and urinary tract infections. All the conditions listed are preventable and curable or treatable. So when a child has fever in Nigeria, it is usually due to at least one of the listed diseases. If appropriate medical care is not provided in good time, the health situation may deteriorate and cause serious complications or even lead to death. Besides the danger posed by the progression of the disease pathology, the progression of the fever can also lead to convulsions; this is known as Febrile Seizure/Convulsion.

Febrile seizures occur in children aged between 3months and 5years of age. It is triggered by high body temperature in a sick child. It can lead to permanent disabilities or death. Sometimes the body temperature can be very high and may not be detected by palpation; the most objective way is by measuring it with a clinical thermometer. Every family with children less than 5years should have the thermometer at home. The right action to take when one suspects that a child has fever should be to expose the body; if the temperature is above 38 degrees Celsius, immerse a clean piece of cloth in cold clean warm-to-cold water and use it to tepid-sponge the child and take him or her to a health facility for appropriate care as urgently as possible. Delay can be very dangerous. Self medication is very risky especially in children and strongly discouraged. The use of herbal concoctions is also very dangerous and can lead to kidney or liver failure as those organs are too young to metabolize the contents of the concoctions.

Furthermore, we as a people must have to make deliberate efforts to save our children and ourselves from the nightmare caused by the above highly preventable and treatable health conditions. The burden of disease and mortality has remained too high for a long time despite the efforts being made to solve the problem. It is either we are not doing enough or we are not getting it right. It is inexcusable and totally unacceptable for Nigeria to be losing up to a million children annually to childhood killer diseases. According to World Malaria Reports 2011, out of every 4 children with malaria in the world, one is a Nigerian. About 300,000 Nigerian kids die from malaria every year and the financial cost to the country is estimated to be N132 billion annually. On the other hand, pneumonia is also causing havoc and ranks second to malaria as the killer-in-chief of Nigerian children. Studies show that at least 17 children die every hour in Nigeria from pneumonia. Diarrhea may or may not present with fever but is also a major childhood killer disease.

The good news is that many countries have defeated these ailments. Countries like United States had similar experience in the 19^th and 20^th centuries but took measures to make it history. Nigeria can do same and everyone’s effort is needed to make it happen. The main focus should be on primary prevention. It is the duty of government to enact and enforce policies that will create an environment that will make the incidence of the killer diseases negligible. It is also the duty of the Nigerian people to abide by the regulations. Good personal hygiene is key. Childhood immunization and utilization of antenatal services by pregnant women is strongly recommended. On her own part, government at all levels must demonstrate strong political will and strengthen the health system particularly the primary health care. Nigeria is almost always among the top five countries in every poor health index, a comeuppance of chronic systemic corruption and poor governance. All hands must be on deck to reverse the situation and without further delay. Let our children live. Have a splendid and disease-free new year.

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Between Stress, Anxiety and High Blood Pressure (Hypertension)

In my community, whenever someone suffers stroke or is said to have high blood pressure (commonly addressed as ‘high BP’), people would ask, “what is s/he thinking about?” I grew up with the notion that high blood pressure (hypertension) is caused by deep thoughts arising most probably from financial difficulty. But later, some affluent men I knew were also said to have high BP. Theirs were said to be caused by “stress” – that rich people were always ‘stressed up’ thinking about their money.

A few weeks ago, I was watching Cable News Network and I was amazed with the news of Frankie Muniz, a 26 year old American who was diagnosed recently of mini-stroke. I was wondering what could be responsible for stroke in an apparently healthy young man, but in medicine, you can never say ‘never’. The CNN Chief Health Correspondent, Dr Sanjay Gupta went ahead to interview the actor/musician and he said he started feeling funny, gradual loss of balance and dizziness on his way back from a workout station. The diagnosis was made after clinical evaluation and radiological investigations.

More so, veteran actor, Enebeli Enebuwa was reported to have died last week. He was being treated for stroke (a complication of hypertension) he suffered over a year ago. Was he thinking too much? Was he anxious or under severe stress? What is the relationship between stress, anxiety and high blood pressure? What really causes hypertension? Find out in the following paragraphs.

Blood pressure is expressed as a fraction – the numerator represents the systolic while the denominator represents the diastolic. For most normal people, the systolic ranges from 110 to 120mmHg while the diastolic from 70-80mmHg. It is usually a bit lower in people who exercise a lot which is good. Hypertension occurs when the blood pressure is sustained for a long term at or above 140/90mmHg and can only be diagnosed by a trained medical personnel. Stressful situations can cause your blood pressure to spike temporarily and return back to normal. Doing exercise up to 30-60minutes a day can reduce your blood pressure and stress level too. There is no proof that stress itself causes long term high blood pressure.

What about anxiety? It doesn’t also cause chronic hypertension. But episodes of anxiety may lead to a dramatic temporary blood pressure rise. If those episodes occur too frequently, such as everyday for a long period of time, it may damage some vital organs of the body. Anxiety may also lead one to engaging in abnormal behaviors such as smoking, excessive alcohol consumption, etc which are risk factors for hypertension.

Hypertension is mainly of two types: primary (essential) and secondary. The primary type is commoner and the cause is yet-to-be known. There are factors that increases a person’s chance of developing hypertension, they include – overweight, obesity, smoking, men above 50yrs, postmenopausal women, etc. Some of these factors are not modifiable, for instance, you don’t need to change your sex to avoid the risk of getting hypertensive. How do you know whether you have hypertension or not? You can only know by checking your blood pressure. If it is very high, you may be required to rest for about 4hours and it is repeated. Hypertension does not usually show any symptom or sign until it gets complicated. It damages the blood vessels, heart, kidney, etc gradually and the damages caused may not be reversible if the hypertension is not identified and controlled in good time. Some of the complications include but not limited to the following: stroke, heart attack, chronic kidney disease and dementia. Secondary hypertension is caused by some health conditions and disappears when the causal disease if treated/cured.
Treatment for primary hypertension is for life. Strict adherence to medication as prescribed by the doctor is strongly recommended. I’m not aware of any scientific proof that herbal medication is effective; rather, it may damage the kidney and cause a sharp rise in blood pressure and may result in stroke or sudden death. It can be very debilitating. 
In conclusion, stress and anxiety don’t cause long-term hypertension. Early diagnosis and treatment of hypertension will prevent complications which can lead to sudden death. Do regular exercise, avoid tobacco smoking, eat healthy foods and check your blood pressure at least once in a year if you are less than 50years. Have a good week.

 If you have questions, kindly mail them to leze@happynigeria.org. Follow me on twitter - @donlaz4u

Road Safety: Between Prayers and Behavioral Change

About this time 5years ago, I met with my cousin Chukwuma who had just started his business after 7 years of apprenticeship. He had his goods on a mobile truck which he pushed round the streets of Ibadan to make a living. Then I was in my final year in medical school. Chukwuma and I grew up together and I had wished he was in school like me. We shared ideas on how he can grow his business and get a shop. I was looking forward to when I would graduate and make some money to be able to assist him raise some capital. Later that month, he travelled home for the Christmas holiday. On his way back to Ibadan, he died in a road traffic accident alongside other 18 passengers on board a commercial bus. May his soul continue to rest in peace.

What could have led to the accident? Could it have been due to bad road network, bad weather, vehicular technical problem or over-speeding, drunk-driving, or other practices that violate of traffic regulations? Could it have been caused by evil spirits (the usual culprit in sad events with unfound causes or with causes we refuse to accept)?  I don’t really know; but must have been due to at least one of the above. Most of the roads across the country are in deplorable conditions, the level of indiscipline among road users is terribly high while the ineptitude or endemic corruption among the enforcers of traffic regulations remains unacceptably high.

Before my cousin’s demise, I’ve seen many victims of the daily carnage along Lagos-Ibadan expressway being treated at the University College Hospital, Ibadan. Besides, I’ve also been involved in at least 4 road accidents in commercial vehicles (along Lagos-Ibadan, Abakaliki-Enugu, Asaba-Benin and Abuja-Lokoja roads); thankfully, I left unhurt unlike many other co-passengers. The major problem here, in my opinion, is not lack of knowledge about the causes of the road accidents but the lack of will by individuals to adopt favorable behavioral changes. Politicians have continued to award road contracts with poor or no execution. The system is not also doing enough to enforce the existing regulations. Many people hold on to this assumption that most road crashes are caused by evil spirits or “enemies” and consequently fail to take preventive measures seriously. That’s absolutely ridiculous.

I believe in the existence of spirits – good and bad, I also believe in the power of prayers; but I do not agree that prayers alone will provide the solution to accident-related morbidities and moralities. Even the bible said that “prayer without work is dead” Prayers are not lacking in Nigeria, what is lacking is the “work” component. The Federal Road Safety Commission has improved in recent times as has made good safety policies like use of helmet, seatbelt, compliance with traffic regulations, etc. However, according to Road Safety Report of 2010 by World Health Organization, helmet wearing rate in Nigeria is less than five percent and more than 50 percent in Chad. It might interest you to know that in more pedestrians, bicycle and tricycle vehicles users die from road accidents than users of other vehicles. I think road safety did a lot in publicizing the laws, the people need to change their behaviours, the enforcement agents need to step up and deal decisively with identified violators in line with the provisions of the law.

Road traffic accidents is one of the leading causes of death among people aged 15 to 49, the most productive age group in the country. Sadly, Nigeria has not prioritized investment in the improvement of road safety. The people themselves have jaundiced assumptions on the causes and required solutions to it.  If it’s all about evil spirits, the prayers said daily in motor parks, churches, mosques, shrines, etc would have stopped road accidents. As we continue to pray, let drivers stop getting intoxicated with local kparaga before hitting the roads, let all road users observe traffic regulations (many Nigerian road users don’t even know them), let the government at all levels make our roads smooth, wide and usable,  let FRSC sanitize itself and give drivers license only to those who have adequate knowledge of road traffic laws and good driving skills, let the police enforce the law especially in all traffic offences, let the government strengthen the medical emergency system to effectively attend to people who may inevitably be involved in accidents and let every individual resolve to be law-abiding.

 As people travel to different parts of the country to spend the Christmas holiday with their loved ones, it is my hope that compatriots will drive carefully so as to reach home alive and safe. Prayer only is not enough, act right!