AN EXCLUSIVE INTERVIEW WITH DR. ETTA --by Nickz

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.