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Why Health Care in Nigeria Remains a Game of Lottery
By David Eboh and Prince Charles Dickson
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The Politics of Healthcare in Nigeria: A Game of Lottery? (I)
It remains unclear how best to define and describe Nigeria’s healthcare delivery system. The National Healthcare Insurance Scheme (NHIS) has been established as a way out of the limbo for people that would have difficulties in accessing, paying and receiving appropriate healthcare services anywhere in the country. However, many of those championing NHIS and Health Management Organisations (HMO) are divided on several opposing lines and boundaries of personal interest in the industry. This is one of the significant challenges for the realistic implementation of NHIS project and the full development of a viable and sustainable healthcare services and delivery system in Nigeria. There is evidence to assert that the commercial interest that would maximise the gains of a few out weighs the argument in favour of public interest that would benefit the entire population.
There are several options for realising the potential of healthcare economy in the country, but the preferred choice is usually one that is hardly subjected to any serious experts’ analysis and public scrutiny. The decision on the option is made without due reference to specific research or based on established evidence of success in similar countries or societies, which would allow informed response by members of the public, especially the academics. There is undue reliance on narrow angle view of medical professionals without consideration of the holistic concept of health services business in the view of strategic management experts.
The politics of healthcare in Nigeria disempowers the majority of the citizens by denying them the fundamental basic knowledge of what, how, where and when the issues of healthcare are being planned and implemented. And once a professional group approves a political agenda, it becomes the right policy for the country irrespective of the faults and deficiencies.
Healthcare policy is neither aimed to achieve a national delivery system with standardized approach for equality of access, quality concepts, strategic management, funding and marketing, individual and organisational accountabilities, workforce recruitment, training and development; nor does it aim for respective states to channel their own courses without any connection to the centre. The disjointed co-ordination of the leadership structure and absence of management discipline have impacted negatively on effectiveness and efficiency in system development of a clearly definable healthcare in the country.
At the moment healthcare delivery is like a game of lottery where only the lucky ones can have access to healthcare services at the mercy of a Non-Governmental Organisation (NGO), Governor, President, Vice President or their respective wives, (our first ladies).
One of the legacies of military dictatorship is a policy of undue discretionary use and abuse of power where funding for specific healthcare needs of selected individuals either for treatment at home or abroad without concerns for the rest of the population. With democracy, it is important to point out the implication for non-universal approach for assessing and paying for specific healthcare needs of the citizens. There is a need to highlight that while charities can chose and pay for healthcare needs of individuals because it is their own money, people trusted with public responsibilities could not spend public fund for specific people with specific healthcare needs discretionally without subjectivity to processes that ensures equity and fairness. Public fund belongs to every member of the public and must not be used or seen to be used in manners that undermine a leader’s commitment to addressing the healthcare needs of the general public.
When the wives of our President and Governor of Lagos State, Mrs Hajia Turai. Yar’adua and Mrs Fashola, addressed the issue of health and the free treatment of 500 people with visual problems which was initiated by Her Excellency, the First Lady of Nigeria, the question that called to mind was about the source of fund that paid for the treatment. Was it private fund, charity fund or public fund? Similar number of patients are hoped to benefit across all the states in the country. While this critical question does not underscore the kind gesture of the first ladies and the magnitude of the benefit derived by those targeted, it however does raise the issue of clarity in systems, needs assessment and responsibilities for planning, costing, delivering and evaluating healthcare services on the basis of priorities, the expected cost/efficiency value for both the individuals and the general society..
In view of the above, it would not be inappropriate to ask about the significance of national health insurance scheme (NHIS), considering the fact that access to healthcare services may be a mountain to climb by those whose needs are not championed by someone with a particular political interest. There was a case of two people with renal (kidney) problems who required transplantation as reported on NTA news where their doctor was appealing for donations to fund their treatment. The boy was 9 years old and the female was about 42 years. There was no evidence of much response from the charity organisations (NGOs), the government of their state of origin or residence, the politicians or the federal government and others. It is uncertain what the outcome of their fate is. There are several members of the population sharing that fate and if not for the foresight of their doctor, no one would hear of their suffering simply because a country as blessed as Nigeria is yet to develop and improve upon its healthcare industry, efficient management and effective delivery systems.
So far, the song of healthcare reform in Nigeria does not seem to be in tune with the beat of the music in the systems of delivery. It continues to sound more like rhetoric with so much promises but little guarantees for realisation.
For realistic achievement in the national agenda for effective healthcare delivery in Nigeria, we must first identify who the experts are in strategic management of healthcare and consult widely across their range in order to have a balance debate that is anchored on clear principles of research evidence and international benchmarking. Also, the business activities of healthcare must be distinguished from the clinical activities and productivity and should be positioned as a fundamental public service directed at every member of the population.
The subject of healthcare should start to attract more public questioning and expert analysis. The media should play the moderator’s role by pushing the debate and accommodating the different opposing arguments. Publishing one side of a story diminishes the opportunity for learning and knowledge development. Healthcare management issues are sparsely reported and yet many organisations across the public and private sectors lost millions of naira per day due to sickness absence. Performance of staff due to poor health affects productivity, quality and profitability, yet the media is more concerned about other economic news that has direct visible financial values.
Prince Charles Dickson
Nigerian Physicians Abroad Invites ANAC and the Nigerian Stock Exchange
By Paul Oranika
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ANAC/ ANPA/The Nigerian Stock Exchange: The Meeting of the Minds in Charlotte, North Carolina
By Paul Okechukwu Oranika
All Nigerian American Congress (ANAC) was invited by the Association of Nigerian Physicians of America (ANPA) to address its members at the yearly Convention of the Association, which was held at the Omni Hotel in downtown Charlotte North Carolina. The event drew many VIPs from all parts of the United States, Nigeria and elsewhere, partly because it coincided with the Nigerian Stock Exchange Exhibition, which targeted Nigerian Professionals living abroad. Addressing a packed crowd of Nigerian Professionals, the Director General and CEO of the Nigerian Stock Exchange, Professor Ndi Onyiuke Okereke invited Nigerians to take advantage of investment opportunities within the Nigerian Stock Markets by investing their money in Nigerian Stocks. Her message was well received by potential Nigerian Stock investors, some traveled from neighboring States to be at the event.H.E Chudi Okafor was invited to the podium to deliver his adress which focussed on the importance of being part of NIDO, followed by inauguration of the NIDO North Carolina Chapter, Dr. Salisu Abdullah who is also the Chairman of Zumuta Northern Peoples Association also witnessed that segment of the event.
After buffet style- launch, courtesy of the Nigerian Stock Exchange, across the hall in another banquet hall, ANPA's Conference continued after the break, soon word was passed on to ANAC representatives, led by Chairman of the Board, Hon. Akeem Bello, that the stage was set for ANAC to deliver a condensed message to the rank and file of ANPA delegates. Members of the ANAC Board of Trustees, former ANAC president Chief Temitope Ajayi and Paul Okechukwu Oranika joined Chairman Bello at the Podium as he delivered a well-crafted message to ANPA, whose President Dr. Yele Aluko reiterated the fact that ANPA is not a political organization.
Folks I have never before been in a large gathering of Nigerian Physicians in one room perhaps in the hundreds, representing many thousands of ANPA's large membership. One thing we know for sure is that if any Nigerian fell ill at this gathering in North Carolina, there would be plenty of well trained and qualified Nigerian Doctors to offer some help. Soon Bello was invited to speak and the Chairman accompanied by ANAC members took the center stage as the friendly audience waited quietly.
In his opening remarks, the ANAC Chairman said, I would like to thank Dr. Yele Aluko your current President and a well recognized Cardiologist in the Charlotte, North Carolina area and all the members of the ANPA Board of Directors and all the organizers of this event as well as all members of ANPA for giving us an opportunity to speak before this august body of distinguished Nigerians, indeed you all are a success story of your own.
Bello further told ANPA that ANAC idea was born because Nigerians needed an organization that would represent the interest of all Nigerians abroad without involvement or interference of the Nigerian government, Bello drew large applause when he mentioned ongoing efforts as the chief Deponent of the law suit seeking from the Nigerian High Courts an order granting all Nigerians living abroad the right to vote in Nigerian elections. ANAC's message was well received by ANPA, amidst applauses from ANPA members. After that brief address, ANAC representatives exited the hall, as ANPA progressed to their closed-door session for their elections.
Later that evening was the Gala event, which attracted hundreds of Nigerian professionals from many States, Nigerian Stock Market executives, Professors, Ex-Nigerian State Governors, and others. Standing out among the crowd were H. E The Nigerian Consulate General in Atlanta, Hon. Chudi Okafor, Senator Dr. Aloysius Akpan Etok. (JP) Chairman Senate Committee on Rules & Business, Senator Ganiyu Olanrewaju Solomon, Senate Federal Republic of Nigeria, Senator M.A Bello Kano Central Senatorial District, and former Governor of Anambra State, Dr Chris Ngige.
The event attracted significant media coverage, including The Nigerian Television Authority (NTA), a London based TV organization, many Nigerian Newspapers, Nigerian Online News Publications and Journals, as well as the Upscale Atlanta based Publiciti Magazine whose Editor-in-Chief Ms. Lola Sanusy was also among the important personalities who graced the event. Food and Music were very good as attendees danced the evening away. An estimated 300 members of the Nigerian community attended the Gala.
Written by Paul Okechukwu Oranika
email: oranika@aol.com
Nigerian Treated for Rare Heart Condition in the US
Transatlantic World News Report
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NIGERIAN BUSINESS MAN TREATED FOR RARE HEART CONDITION
IN THE USA
Alhaji Baba Ndagana, a 33-year-old business man, traveled all the way from Nigeria to come to Advocate Christ Medical Center in Oak Lawn, Ill., to receive successful treatment for coarctation, a very rare congenital heart condition that is normally diagnosed in utero and surgically treated at birth. This is a condition that causes severe hypertension and restricts necessary blood flow from the heart to the other major organs in the body.
To celebrate the success of his treatment, The Consul General of Nigeria and other key dignitaries traveled to Advocate Christ Medical Center to pay a visit to Alhaji, also known by his nickname Baba.
Baba initially came to Advocate Christ Medical Center for an aortic aneurysm repair and aortic valve replacement. However, what Baba and his friends and family didn’t realize was that there was another condition lurking undetected within him until he came to Christ Medical Center for treatment.
An angiogram and CT scan quickly revealed that Baba was suffering from coarctation. If it continued to go undiagnosed, it could eventually lead to kidney failure and possible stroke at an early age.
According to his U.S. attending physician, Dr. Abdulateef O. Kareem, “Most patients that go untreated with this condition usually do not survive past the age of 12. He is very lucky that we were able to bring him here to Christ Medical Center for treatment.”
Dr. Kareem, who travels to regularly travel to Nigeria for Volunteer medical missions was there for a convention and was introduced to Baba a few months prior in Africa by World Medical Relief Chairman Mr. Roger Matthews, Dr. Kareem talked with Baba’s physicians and agreed to supervise his care in the U.S.
Christ Medical Center’s cardiac surgical team of Dr. Pat Pappas and Dr. Antone Tatooles led the successful surgical intervention with Baba.
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After undergoing two open heart surgical operations in ten days interval Baba is doing well.
The outcome for Baba looks very promising and he is scheduled to be discharged and will be going back home to Nigeria.
'Gender equality' of lung cancer
Women who smoke are no more likely to develop lung cancer than men, US researchers have concluded.
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There had been conflicting evidence on women's risk, but the National Cancer Institute study of over 450,000 people found no gender difference.
The study published in Lancet Oncology found a difference of only 0.9% between the risk for men and that for women.
The most recent UK statistics show that in 2006, 23% of men and 21% of women were cigarette smokers.
Lung cancer kills around 30,000 people a year in the UK.
'Vigorous efforts needed'
The researchers analysed data on smoking habits, diet, exercise and alcohol use for 279,214 men and 184,623 women aged between 50 and 71 living in eight US states.
They then looked at lung cancer rates.
The difference in risk for women and men who smoked was just 0.9%.
Men and women who smoke more than two packs per day were about 50 times more likely to develop lung cancer than people who had never smoked.
The team, led by Dr Neal Freedman, said their study benefited from its size, giving reliable findings
They conclude: "Our findings suggest that women are not more susceptible than men to the carcinogenic effects of cigarette smoking in the lung.
"Vigorous efforts should continue to be directed at eliminating smoking in both sexes."
Andy McEwen, assistant director of tobacco studies at Cancer Research UK's Health Behaviour Research Centre, said: "Smoking has a devastating effect on the health of people trapped by their tobacco addiction.
"The risk of a smoker, male or female, developing lung cancer is 15 times greater than that of a non-smoker and smoking continues to be the biggest preventable cause of death for men and women."
"Smoking accounts for the vast majority of cases of lung cancer worldwide.
"More has to be done to help all smokers to quit if we are to prevent future deaths from lung cancer."
'Slow movement' wants you to ease up, chill out
Edgar S. Cahn is fighting for your right to be lazy
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Other activists might devote their time to reversing global warming or saving the whales. But the 73-year-old attorney is battling to preserve a commodity that he says is more fragile than the environment and more precious than oil -- time.
Cahn is a leader in the "slow movement," a national campaign that claims that speed kills. Its leaders say that Americans are so starved for time, our need for speed is destroying our health, families and communities.
They say we live in a culture in which being overworked has become a status symbol. Cahn created TimeBanks USA, a nonprofit group that treats time as money, to put the brakes on people's high-velocity lifestyles.
TimeBanks members barter blocks of time known as "time dollars." One member may, for example, buy groceries for a stranger in exchange for someone else walking their dog."Time is the most precious thing we have," he says. "Every hour you live, you never get back." Slow movement members don't fit one profile. They're journalists, lawyers, chefs, farmers. Yet they cite the same factors for our inability to slow down: longer work hours, longer commutes and technological advances like BlackBerrys that keep many employees chained to work.
They suggest people combat "time famine" by practicing random acts of slowness: turning off the BlackBerry, cooking unhurried meals with friends, cultivating a garden and taking long walks.
Some have even formed groups to encourage individuals and businesses to save time. They include:
• The Long Now Foundation, a group based in San Francisco, California, was established to provide an alternative to a "faster/cheaper" mind set and promote "slower/better" thinking.
• Take Back Your Time, a nonprofit group based in Seattle, Washington, is leading a national campaign to address time famine by using conferences and teach-ins to wean people off their need to be busy.
• Slow Food USA is a nonprofit group that offers an alternative to fast-food eating and industrial food production. It encourages members to plan communal meals and use farmer's markets. It has at least 80,000 members in 100 countries.
Cahn, from TimeBanks USA, says he came up with the idea for time banks in 1980 after he suffered a massive heart attack from a frenzied lifestyle that included being a speech writer and the founder of a national legal services program and a law school.
Time, he thought as he recovered, doesn't have any monetary value attached to it. One can't deposit a block of time in the bank or buy a loaf of bread with it. Yet it's essential to have enough of it to live well and make democracy work, he says.
"The market doesn't value what it takes to build community or democracy or to fight for social justice," he says.
The slow movement is not just content with saving people time, though. It's ultimately about shifting people's values, Cahn says.
"The movement is about how we value things other than how fast we can consume and how much we can accumulate," he says.
It's also about changing public policy, other slow movement leaders say.
John de Graaf, national coordinator for Take Back Your Time, says the nonprofit group is calling for legislation guaranteeing at least three weeks of paid annual vacation for all workers, paid leave for all new parents and workplace rules limiting the amount of compulsory overtime.
Companies will actually profit more if they don't overwork employees because they will become healthier and more productive, he says. He points to the robust economies of Western European countries, which treat their workers to more vacation time and shorter work weeks than their counterparts in the United States.
"If you live in Europe after the age of 50, you're only half as likely to develop chronic illnesses like heart disease and high blood pressure as those in the U.S.," he says. "People exercise more, they eat less food and they sleep more."
Slowing down won't only save lives; it'll save democracy, de Graaf says. His group is also pushing for laws that allow people to have election days off.
Democracy can't exist without informed citizens, he says. People need time to pay attention to the news, attend city council meetings and keep elected official accountable. He hopes both presidential candidates will address the issue of time famine. People can't keep living nonstop lives, he says. Something has to give.
"When you come to the edge of a cliff, the solution is not to run faster," he says. "We have to step back."
German shops running out of milk
Shops in Germany say they are starting to run out of milk after days of protests by dairy farmers against what they say are unsustainably low prices.
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The German milk industry federation said that blockades of milk processing plants by angry farmers had cost the industry nearly 50m euros (£39.5m).Protesters have also emptied milk tankers onto the ground.Farmers are demanding a minimum price of 0.43 euros (£0.34) a litre - at least 20% more than the current price.They say rising fuel and feed costs have pushed up their operating costs but the retail price of milk has not increased correspondingly.
'Delivery bottlenecks'
Since the main dairy federation, BDM, began its strike on 27 May, retailers have been warning people not to rush out to buy milk, but at some of the big supermarkets supplies are now running low.
The discount supermarket chain Plus said it was seeing isolated shortages, but said it could cover them with stock from unaffected areas. Another chain, Real, also said supplies were running low at some locations. The director of the Association of the German Dairy Industry (MIV), Eckhard Heuser, also said its supplies were getting tight.
"There are delivery bottlenecks and they are increasing by the hour," he told the Financial Times Deutschland.
The MIV estimated that the strike had so far cost milk processing plants about 50m euros, but said the figure could be larger.
BDM chairman Romuald Schaber has called on his federation's 32,000 members to continue to refuse to deliver milk to dairies, although they will relax their blockades stopping deliveries by farmers not participating in the strike.
"The farmers are determined to continue their action until they achieve success," he said.
Agriculture Minister Horst Seehofer has stressed that a "rapid solution is in the interest of all" and that it is crucial for Germany not to become dependent on milk imports.
"With energy supplies, we have seen how such dependency can cause problems for the economy," he told the Passauer Neue Presse.
"Only if milk producers are able to exist will we avoid foreign purchases of raw materials that are important for food production," he added.
Milk producers in neighbouring countries, including Belgium, Austria and Switzerland, have urged dairy farmers to join the strike or not to export to Germany.
CONSULATE GENERAL OF NIGERIA PAYS VISIT TO PATIENT WITH RARE HEART CONDITION AT ADVOCATE CHRIST MEDICAL CENTER
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Alhaji Baba Ndagana, a 33-year-old business man, traveled all the way from Nigeria to come to Advocate Christ Medical Center in Oak Lawn, Ill., to receive successful treatment for coarctation, a very rare congenital heart condition that is normally diagnosed in utero and surgically treated at birth. This is a condition that causes severe hypertension and restricts necessary blood flow from the heart to the other major organs in the body.
To celebrate the success of his treatment, The Consul General of Nigeria and other key dignitaries traveled to Advocate Christ Medical Center to pay a visit to Alhaji, also known by his nickname Baba.
Baba initially came to Advocate Christ Medical Center for an aortic aneurysm repair and aortic valve replacement. However, what Baba and his friends and family didn’t realize was that there was another condition lurking undetected within him until he came to Christ Medical Center for treatment.
An angiogram and CT scan quickly revealed that Baba was suffering from coarctation. If it continued to go undiagnosed, it could eventually lead to kidney failure and possible stroke at an early age.
According to his U.S. attending physician, Dr. Abdulateef O. Kareem, “Most patients that go untreated with this condition usually do not survive past the age of 12. He is very lucky that we were able to bring him here to Christ Medical Center for treatment.”
Dr. Kareem, who travels to regularly travel to Nigeria for Volunteer medical missions was there for a convention and was introduced to Baba a few months prior in Africa by World Medical Relief Chairman Mr. Roger Matthews, Dr. Kareem talked with Baba’s physicians and agreed to supervise his care in the U.S.
Christ Medical Center’s cardiac surgical team of Dr. Pat Pappas and Dr. Antone Tatooles led the successful surgical intervention with Baba.
-more-
After undergoing two open heart surgical operations in ten days interval Baba is doing well.
The outcome for Baba looks very promising and he is scheduled to be discharged and will be going back home to Nigeria.
Oregon's healthcare lottery
In what is believed to be the first such move, a US state is running a lottery in which the prize is health insurance.
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With some 45 million Americans uninsured, how to pay for medical treatment is a big issue in this year's presidential election. Now officials in Oregon say they have come up with a fair way of providing coverage for some of those who cannot afford it. In her comfortable home in Portland, Oregon, Louanne Moldovan sifts through a pile of papers.
They are unpaid medical bills, stretching back a year, arising from treatment for Crohn's Disease, the chronic intestinal condition she suffers from. She thinks she owes nearly $15,000 (£7,500) in all. Louanne says she is looking for full-time employment but, she adds, her earnings through freelance work will not buy enough health insurance for the treatment she needs. For her the state healthcare lottery offers an uneasy solution.
"It's a symbol of how degraded our system is in this country that we are resorting to a lottery," she tells me. "It's pathetic and repugnant at the same time... [but it's] a necessity because I don't earn thousands each month."
'Sad reflection'
Many do not share her feelings, but Louanne is not alone in trying her luck. More than 90,000 in Oregon are vying for a maximum of 10,000 places in the state's healthcare plan. Yet it is a drop in the ocean. There are some 600,000 uninsured in Oregon.
At the Outside In community clinic in downtown Portland, doctors see 7,000 different patients a year, 90% of whom have no health insurance. The clinic's director, John Duke, says the lottery provides hope for the few who are picked but is indicative of a wider problem.
Insurance 'winners'
Among a sea of identical office cubicles in the state capital Salem, two women sort, staple and stamp their way through a large pile of application forms. These are the first 3,000 names randomly selected by computer. They could be the lucky ones but first their eligibility must be verified with bureaucratic precision. It can take up to 30 days before these people know if they are "winners" of health insurance. Some of the 3,000 will turn out to be ineligible for a variety of reasons. But the lottery will continue drawing out names until the 10,000 places are all filled up.
Louanne Moldovan's name was not in that first batch. Back in her suburban Portland home, she shows me the bathroom cabinet full of the medicines she has taken over the years. Some treatments went unfinished as her diagnosis was refined. Still, everything needs to be paid for. For now, the pills and the bills continue to pile up but there is always next month's lottery draw.
"I think it says it's a pretty sad state of the health care system in Oregon and in the nation as a whole," he says. "I think the system is falling apart and it needs some radical deep change. "This is a small Band-Aid. I think the best it can do is draw attention to the problem and maybe bring change in that way."
Drawing attention
The question of how to pay for medical treatment is increasingly a function of the country's wider economic worries and is an important campaign issue for presidential hopefuls. Yet Oregon's Director of Human Services, Dr Bruce Goldberg, hopes national leaders will take note of his state's efforts but not copy them.
"I hope what they're working for is not a national lottery..." he says.
"I think it's an issue about how to use this as an example of what the problem is.
"I mean this is about real people and real people's lives."
And lotteries can change peoples' lives.
Twice a week on TV, as millions watch, numbered balls are drawn from a rotating drum, and someone somewhere wins millions of dollars. Oregon's healthcare lottery could be equally life-changing but is much less glamorous.
Italy to withdraw tainted cheese
The Italian government says it is ready to withdraw from sale the mozzarella cheese linked to dioxin contamination.
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Italy's health ministry said the affected cheese came from 25 producers in the Campania region near Naples, where buffalo mozzarella is made. French authorities have told shops to remove Italian buffalo mozzarella. In the UK, officials said there was no immediate risk to consumers. However, the European Commission had urged Italy to improve safety measures. Italian Foreign Minister Massimo D'Alema said: "The government will this morning take the steps agreed with the European Union to withdraw from the market products that do not comply with standards." The contamination emerged during checks last week. Dioxins, which can cause cancer, were found at higher than permitted levels at some mozzarella producers.
The affected cheese is the finest traditional variety, made from buffalo milk.The French agriculture ministry on Friday ordered shops to withdraw the imported buffalo mozzarella as a precautionary measure.A European Commission official told the BBC News website that "there is not an immediate health risk" but that Italy needed to act to comply with EU rules.
"The levels of dioxin are not excessive but they are over the maximum recommended amount, so measures have to be taken to decrease these levels," the official said. Italy says it has traced the farms at the source of the contamination, and destroyed their milk. Japan and South Korea have already imposed an import ban on the cheese.
Suspect rubbish dumps
In the UK, the Food Standards Agency said: "We are currently not aware of any contaminated buffalo mozzarella being distributed in the UK. "However, we take any risk very seriously and are currently talking to Italian authorities about this issue." Italian officials told the European Commission that 130 mozzarella production sites had been checked and dioxins above the EU limit had been found at 25 of them. Police are investigating whether feed given to herds around the city of Naples was tainted. It is believed the cause is toxic waste, illegally dumped by criminals on agricultural land used for pasture. Mozzarella is big business in Italy, with herds of a quarter of a million buffalo producing a total of 33,000 tonnes of mozzarella cheese each year, 16% of which is exported.
Sierra Leone slum medic
Adama Gondor, who runs a clinic in a coastal slum of Sierra Leone's capital, Freetown, is keeping a diary for the BBC News website about her work.
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A severely malnourished child was brought to the clinic on Monday.The baby was eight months old, but she only weighed 4.5kg.If we assume she had the average weight of 3.3kg when she was born she should have been getting close to 9kg by now.The baby was very thin, with bad skin and looked more like an old man - it's awful to see a baby in such a condition.She also looked very hungry. We immediately referred the baby to the hospital quite far away in the east of Freetown where there is a therapeutic feeding centre.The mother took her straight there and she was admitted - the programme is free.
Herbs
Recent research by a university student in the community found that 95% of the population here cannot afford to buy proper nutritious food. Their diet is not balanced and many children are malnourished but to see such a child is unusual.The mother told us she had been feeding the baby rice porridge, which is just carbohydrates and does not give enough nutrition.She also said the child had been sick and she had been giving her native herbs.I suspect that the herbal medicine may have had a part to play in this as an eight-month-old baby does not have a very developed liver and the various herbs could have been poisoning her and making her condition worse. The mother waited to come to the clinic till the situation was really severe.
In Kroo Bay in addition to this clinic there are both traditional healers, who use herbs, leaves and local medicine, and medical quacks, who pretend to be doctors and nurses and use modern medicine.People often prefer to go to traditional healers because they come from the countryside and feel more comfortable approaching them.Also it is cheaper and sometimes we have to send people away when we have no drugs in the clinic.I am not so worried about the external medicines they give people to put on their skins - like the chicken pox paste I described last week - but some of the ones they tell people to swallow can be poisonous, especially for a small baby.
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