PREVENTABLE CAUSES OF DEATH—THE MEDICAL PERSPECTIVE
A Gist Creek Interview with Dr. Otu Etta
It was a beautiful Tuesday morning when a section of the Gist
Creek team walked into the hospital building for a special purpose. The expected
air of antiseptics and drugs welcomed us as we exchanged pleasantries with the
smartly dressed nurses at the desk. We would have loved to watch the TV at the
reception area a little more but it was a business movement; we came to interview
Dr. Etta.
Dr. Otu Etta is a young and distinguished Medical Consultant,
an Anesthesiologist and an Intensivist in one of the country’s recognized
hospitals, a successful medical practitioner who bags many years of medical
experience within and outside the country. The cheerful-looking and
happily-married father of four hails from Oron Local Government Area in Akwa
Ibom State, Nigeria. Amidst his busy schedule, he honoured our request for an
interview.
Gist Creek: Thank you Sir for the introduction. Looking
at the death rate in our society today, we believe that certain causes that
could have been prevented are responsible for this. Please educate us on some
of these common causes of death from the medical perspective, and how they
could be prevented.
Dr. Etta: Thank you very much. It is appalling
that coming from Africa, being an African and a Nigerian, puts you at risk of
dying young. Statistics have shown that the average life expectancy of a male
Nigerian is 47 years and female is 49 years, compared to life expectancy in the
advanced countries like the US; the UK which is about 80-something years;
India, about 61, Sweden, over 80 and so
on.
Originally, we know that from Bible, we’ve seen that the days
of man are about 120 years. Then if you’re in Africa, you begin to ask yourself;
why are our people dying young? You know at 60 years, 70 years, you still have
a lot of things to do, but our people are going so young. If you walk around
the streets, you see obituary posters, average age is not far from what I’ve
told you; 40 years, painful exit, gone too soon, and what have you, you know.
It causes for concern, especially when the causes of these deaths are
preventable. It’s saddening; it saddens you both as a doctor and as a human
being. And what are the things that are killing our people? We realize that the
causes of these deaths are things that we can prevent.
Let us take for instance, the commonest cause of death in
this country still remains trauma; trauma-related deaths, like accidents,
falls, collapsed buildings, and all that. You can bear me witness that in the
days where motorcycles were allowed in Uyo, the number of accidents and
accident-related death was so high but since the ban came, some of those deaths
have reduced. And if you look at accidents, if we have a good legislation on
ground, the country can actually sort out all these things. Number one, why do
accidents occur? The problem could be because of the roads; if our roads are
not good, the driver; if he’s not authorized to use the road. So these are some
of the factors. Now, what is the problem? Why can’t we fix our roads, is it
that our country is so poor that we cannot fix roads? No. Our leaders, our
governors, people who have sat on the wealth of the nation, you know,
appropriate these things to themselves and will not use it for the purpose it
was meant.
You and I also know that if you need a Nigerian driver’s
license today–whether or not you have been trained to drive–you can be offered
within few minutes but in those days, still in this country, before you get a
driver’s license, you’ll have to go through series of tests for them to know
who you are; for them to examine your sights, if your vision is normal. They’ll
assess your mental status, whether it’s stable or not, they’ll interview you,
whether you have epilepsy, they’ll get to know your history. If you have a bad
history–you’ve been a drunkard or what–the certificate will not be offered to
you. And even those who have the license, how experienced are they? Which
driving school did they go? Nobody asks
all these things. That is how we allow these people infiltrate the society and
when these people sit behind the wheels, it constitutes a risk to himself and
other people.
At the hospital recently, we had a case of a pedestrian who
was knocked down. The story has it that he was knocked down by a 19 year old
mechanic apprentice who carried a customer’s car that was taken to his boss’
workshop for repairs. He wasn’t licensed to use the road but he entered the car
and began to drive and unfortunately for this young man, he was just walking
after work, in the evening and he was knocked down. We tried everything we
could do to keep him alive but that was all. So, if our legislation will be
very, very forceful in ensuring that the right people use the road, many of
these accidents, we’ll not hear them. Studies have shown that in advanced
countries, they don’t have as much death from trauma like we have here. And
also, the highway codes are not observed. There’re some areas where heavy duty
trucks should not enter. If you live in a residential area, there’re some vehicles
that shouldn’t enter and we have a limit of speed. But here, you know nobody
takes care of all those things. So trauma, trauma, trauma, is the number one
cause of death among our people.
The other cause of death–of preventable death–is infection;
infection–related causes, okay? When we talk about infection, it’s a whole lot.
The chief among this is HIV/AIDS. We all know how many people are dying from
HIV/AIDS. It’s better now because those international organizations have come
in to help with treatment of people living with HIV; NGOs like USAID, Pathfinder,
FHI and all that. Those organizations are really helping our people that are
living with HIV. Some of them are even paid to come out and be tested. The test
is totally free and the care for you after you’ve been started of this
treatment is also totally free. People are offered some incentives now, you
know, you come out and you’re tested, you’re offered cash and all that to
encourage you to take your treatment.
Nigerians have benefited, those who are working with these
agencies have benefited so much. They’ve given employment to people, you know,
and these things are not done by the Nigerian government. The international
organizations are funding these things for our people. Before these agencies
came in, the story was very bad. If you had HIV, it was like a curse; it was a
death sentence because the drugs were so costly then. Before you access drugs
that would take you for one month, it was going for like N20,000. That’s as far
back as ‘99/2000. Cast your mind back, how many people could afford it? If you
have HIV and you go to the hospital and you’re tested positive, doctors will
wash their hands off you. But now, there’re programs and programs that have
come in to even induce some doctors and nurses to take care of patients that
are living with HIV/AIDS so it’s helping.
And, prevention of HIV–you’ve
heard of ABCs of HIV: Abstinence, Be faithful, Condom Use–we’ve come to realize
that some of these things are not working for us. For instance the condom use,
people still don’t think it should be used. Some still go ahead and have
unprotected sex, not knowing the state of their partner, not to talk of Be
Faithful. It’s known that the doctrine of Be Faithful doesn’t work so the
condom use is what is being advocated now. Nobody talks about it, even in the
churches, you know, because some pastors are also involved. So, condom use,
condom use, condom use. If you’re able to abstain from sex completely, it’s
good. If you must have it, be faithful to your partner who is equally faithful
because you can be faithful but your partner is not. If your partner is not,
then he/she puts you at risk. If you do not trust your partner, even if you’re
faithful, you’re encouraged to use a condom. Okay? So if you do this, you’ll be
able to keep HIV at a distance from us.
Other causes of infection are tuberculosis, measles, tetanus,
all that and the good thing is that all those things have immunization.
Another cause of death is pregnancy-related causes. We want
to talk about things like bleeding during pregnancy, hypertension during
pregnancy, infection–all those things contribute to what we call maternal
mortality.
Gist Creek: Are there certain ways of preventing
maternal mortality?
Dr. Etta: Yeah, Sure, sure. Reducing maternal
mortality in the days of MDGs, I think it was Goal 5. You know, there are many
things that could cause the death of a woman while pregnant. The commonest
cause is what I’ve told you, bleeding, what we call hemorrhage. This could
occur when a woman is pregnant or occur after the delivery. There are some women
who are at risk of bleeding; maybe one has had more than four children or five
children, first pregnancy, pregnancy with a woman with fibroid, placenta
problems; those are causes of bleeding during pregnancy and every pregnancy
should be managed by somebody trained.
But we see that in our society, we still have a lot of TBAs taking care
of the majorities of the deliveries…
Gist Creek: TBA is…?
Dr. Etta: Traditional Birth Attendants…taking
care of the women. Because people are religious in this part of the world, some
of them attach church thinking, you know. They even preach to them that if the
doctor says they have to operate on you before you put to bed, that it’s not
the will of God for you. In our language, they say, “Abasi akan uman ikwa,” meaning,
“God forbids delivery by knife”. You’ll be amazed that this belief is also held
strongly by educated ones. You see people with their Masters going to TBAs,
PhDs, you know, so our society really needs a lot of legislation, you know,
proper law in place. How will the TBA know a patience that is not going to
bleed? Apart from those signals I told you–first timer, patient with fibroid,
patient with placenta problem–apart from all these, you still see that even
when a woman does not have all these risk factors, after delivery, some of them
still bleed and you didn’t expect. If the
woman goes to deliver in a center that is not equipped to handle all these
things, what is her fate?
Recently, we saw a woman, at the hospital, we’ve been seeing
several. The last one was a case of a twin, a woman who had multiple pregnancies
and she delivered the first twin there. The TBAs, maybe didn’t know she was
having a twin, while trying to clean her up, saw the hand of the second twin.
The patient was rushed down here, she was bleeding. I came out around 2am. I
was called that a patient has been brought, the hand is out, you know, that,
please doctor please come. I drove out of my house. I didn’t have a security
escort and it was when the fuel price was still at N230. Driving out of the
house, no security escort in a society that’s not very safe, you know how risky
that puts a doctor. If anything happens to me, I’m on my own but because of the
kind of work I’m doing, I came out. We operated on her. Of course the second
twin died but thank God the woman is still alive. We have so many instances of
patients who have lost babies and have lost their lives through instances like
that, so many instances.
So what we are saying is that some of these deaths of women,
there’re some countries that if two out of 100 women who are pregnant die in
one year, it’s a very big issue. In our country, so many of them are dying, so
many are dying, so these are some causes.
Gist Creek: So Sir, can we say TBAs should be
scrapped or should be improvised?
Dr. Etta: You know, in the state now, the government
of Akwa Ibom State is organizing a program to train TBAs on the act of deliveries
and also training them on those red flags, you know, the cases you see and can
refer and the ones you can take. But I tell you, these trainings have been done
before now. My experience is that, and personally, I feel these things are not
gonna work. It takes about 12 years to train an Obstetrician. First he becomes
a General Duty Doctor and spends like 4-6 years for a specialist training to
practice Obstetrics as an expert in that field. If it takes these numbers of
years to train a doctor who has done primary school, secondary school, MBBS before
the specialist course, then you want to tell me that the workshop of one week,
one week training as TBA and giving them the license to practice will solve it?
It’s not going to solve it. So personally, I believe that TBAs may cause more
harm than good because if you give them some level of empowerment to do what
they’re doing, when they’re not knowledgeable enough, you know, eventually,
they’ll cause more harm.
At the same time, we have to balance the argument against our
background. If I also advocate that TBAs should be outlawed, the alternatives
they have is to come to government or private hospitals which are costly.
Gist Creek: It seems most of them run to the TBAs
because of cost.
Dr. Etta: Yes, some of these women are pushed
to the TBAs because of cost, because of cost. The alternative would have been,
okay, if the government says that medical care to women who are pregnant is
free and is accessible anywhere, not limited to government hospitals but to
private hospitals too, that any woman who is pregnant can visit there, receive
treatment free of charge, then the government picks up the bill–they really
will come out. The primary cause why the women are going to TBAs and churches
is because these things are costly. To do one Cesarean Section now in a moderate
hospital is, let me put it at N100,000—N150,000 and you go to some parts in
town, N500,000 and above, so these are some of the reasons why the TBAs may
never go even if you outlaw them now. If insurance is not extended to them and
you outlaw the TBAs, even in their bedrooms, the women will still go for them.
So the problem of the society is complex. And if we say we
establish health centers where the people live, who’s going to run it? Where are
the doctors? Doctors are not being employed, and you go and put a doctor in the
rural area, who has spent all his life in the town, it’s not likely he’ll go.
That’s why some of the doctors live in Uyo and may work in Oron. You know,
sometimes, they don’t go to work, there’s no good road to drive. If they go and
live there, their children will not go to good schools. So the problem is
complex, it’s not like that abroad where everywhere you go to is a town, you
have internet access everywhere, you have good access roads everywhere, you
know. The situation is not the same here. So the problem is complex. There are
a lot of things that can cause death for a pregnant woman including
hypertension and infections and it requires somebody who is properly trained to
take care of some of these.
Gist Creek: Sir, from what you’ve been saying–the
first one on trauma, then infection and pregnancy–do they all come down to the
government?
Dr. Etta: When I talk of government,
government as a whole; the leadership. The leadership being that the executive,
the legislative and the judiciary, everybody is doing his job. And who’s the
government? You and I are the government. If you’re a doctor, are you doing
your work well as a doctor? If you’re a judge, are you doing your work well? If
you’re a legislator, are you there to make laws that will advance the course of
our society? If you’re a governor, the money that was appropriated for road, are
you using it for something else?
If we all join our hands, then, we’ll have a society that
would be better for all of us. It’s not for you to accumulate all the wealth
meant for the society and send your children outside. They go and study outside
but they’ll still come back here. Like in this our state where we live, I
always tell myself, God help you, if you have a problem with your brain, maybe
a trauma or injury to the brain, you’re unconscious, you’ve bled into your
brain, into the head–no matter who you are, no matter what your parents or the
government have spent on you, you may not make it. We don’t have a brain
surgeon in Akwa Ibom State.
Gist Creek: Before we go, what do you have to
say in summary to the readers out there?
Dr. Etta: In summary, my take is that I love
my country Nigeria very much and we have the potentials to equate to any other
developed country. The potentials are there. They abound in our natural
resources and in our people. If we get our acts right, Nigeria can be like any
other developed country in the world; and we have to do our best to reduce the
causes of death among our people. It pains me a lot to hear that life
expectancy in this country is at 47. They use to say that life begins at 40 because
that’s when you’ve finished school, gotten married and settled down to begin
life and you’re told your time is up. It’s a very painful thing. We can reverse
this trend if we all contribute our parts or quota. Nigeria can be better
indeed. Thank you.
