HEALTH INTERACTIVE WITH DR AMINU MAGASHI

HEALTH INTERACTIVE WITH DR AMINU MAGASHI

Traditional Practices and Community Intervention

I would prefer to call them ' traditional practices with health implications than what development partners popularly called them "harmful traditional practices, to me they are only harmful if done wrongly or ignorantly. Two issues prompted this discourse, the first was a story captioned ' 800 ,000 women live with vesico- vaginal -fistula ( VVF ) published in Daily Trust of March, 23rd, 04 page 29, the story which was credited to the country representative of United Nation Population Fund ( UNFPA ), Mr. Miangoran Essan, he reportedly mentioned that a total of eight hundred thousand women in Nigeria have been discovered to be living with VVF, the representative who disclosed that to newsmen in kano recently equally mentioned that 82 percent of those affected are from the northern states of the country and further explained that the statistics shows that most of the victims were found to be below the age of 15 years , hence the prevalence in those states .

The second issue, was my repeated on and off discussion with some one who is a resident doctor working with pediatric department of Murtala Mohd Specialist Hospital in Kano who has over the time exhibit courage and zeal to enlighten parents about the dangers of traditional male circumcision.

Some time back, early this year, there were a lot of cases and admission of children in that department as a result of complication of traditional circumcision, while some of the children admitted died, some suffered complications and may end of being infected with certain diseases like hepatitis and HIV/AIDS. The circumcision that attacks children most, is the type that as soon as a child is circumcised, he will be at liberty to put his trouser, meaning, his private organ is tie completely within a clean rag, the irony of such practice, is the fact that the child has to urinate and because a portal is not provided, his urine will invariably contaminate the rag and the wound , which allows bacterial growth, local infection and invasion of the blood system with organisms and septic agents (septicemia).

In this scenario, the child can die either due to septicemia or tetanus complication. Other long term problems , if instruments are not sterilized is the fear of hepatitis and HIV/AIDS.

These two diseases can also be implicated in the traditional removal of uvula ( uvulectomy ), a hanging structure attach to soft palate within the mouth. The removal of uvula few days after birth can equally lead to massive bleeding. During my house- manship training, I attended to two cases of such and both died because of irreversible shock due to loss of blood. Other practices even though unpopular now, is the female circumcision and this range from exposing infant's clitoris by removing surface skin up to at times removal of some part of it or total amputation of the clitoris. While some believe doing that will dampen the sexual urge of the child which will later on prevent promiscuity, others are of the opinion that such practices will bring out the best in that individual.

Another traditional practice that is still reigning and popular in some northern states of Nigeria is hot bath, which is done after delivery up to 40 days, women are subjected to hot bath and drinking potassium porridge for those days with the believe that such habit will ensure adequate breast feeding and will make them healthier and stronger. Well looking at those practices, scientifically, perpetual exposure to heat will lead to expansion of veins ( vaso dilatation ) and that scenario decreases the process of blood return to the heart and that lead to heart failure, also ingestion of the potassium porridge popularly known in hausa as kunun kanwa will also contribute to weakening of the heart further and in some instances the two encounters lead to post partum cardio myopathy , in a simple language , heart failure , which present with body swelling, to see those cases with naked eyes , is for some one to visit postnatal and medical wards of government hospitals.

Another more worrisome and more deadly problem that claims the lifes of pregnant women on daily basis, most especially in northern Nigeria is eclampsia, a condition of high blood pressure during the second half of pregnancy with fits, convulsion and unconsciousness, in most situation both the potential mother and her unborn child are sent to life beyond by this monstrous problem. When someone visits some public hospitals in the affected states, the ward dedicated to such cases cannot even accommodate the influx of eclamptic patients that need urgent resuscitation and emergency induction of labour or caesarian section.

In this regard, the link to the traditional practices is the refusal by many prospectus mothers to attend antenatal care either ignorantly or the services are not just available. The most astounding and disheartening part of the story is the fact that despite eclampsia contributes highest to maternal morbidity and mortality in the affected states and with more than enough and redundant health NGOs and international donor agencies on reproductive health, I am yet to come across a single intervention targeting specifically at eclampsia.

Coming back to the 800, 000 women living with VVF as being reportedly claimed by the UNFPA boss in Nigeria, personally I have a lot of reservation to this large figure, unless if Mr. Miangoran is willing to share with us his source of data and how that information came about and one will be tempted to ask him, what is his agency doing about all these maternal preventable cases. On most of the victims found to be below the age of 15 years, well that is quite possible, but the biggest challenge to those marrying below that age, is not really the early marriage but early pregnancy couple with the fact that good antenatal care is only for the haves.

Overall, the challenge is on all us, governmental agencies on health, NGOs, international donor partners, parents, media and the society in general and the best option and approach which is more practicable is in form of community intervention, not of course convening workshops that will only end of benefiting the participants at the expense of the larger society. It will be unwise for an NGO or agency to enter a community and categorically call those practices, harmful, because once such pronouncement is made, rejection will be the least to expect from that community.

In a more practicable approach to ensure reduction and/or elimination of health hazards as a result of the traditional practices is to ensure conducting participatory approach research on those practices and equally involving the targeted communities in designing programs which should focus towards enlightenment of the members of such communities through documentary film shows , training of peer educators, holding sensitization meetings and above all providing the most basic antenatal care services with competent, well remunerated staff, 24 hours a day and 7 days a week. And finally enrollment of gild child in primary and secondary schools and to revisit the sexuality education curriculum which in the past had received massive condemnation with the aim of amending such to suit the culture and the environment in which it will be implemented.