Health Interactive with Dr Aminu MagashiHIV/AIDS and Poverty
I will begin this discourse by sharing an experience, which is relevant to the issue under discussion that is, the relationship between Poverty and HIV/AIDS spread and our approach in curving the menace. When I was a Youth Corper under NYSC in Benue State, I managed a rural hospital for a year in Gwer-West LGA . Apart from routine cases of Malaria, Road Traffic Accident, Hypertension and Diabetes, which are found everywhere, I handled a lot of cases of HIV infection and Sexually Transmitted Diseases. I can vividly remember a case of a man in his sixth decade who presented with Chronic Cough, Weight Loss, Severe Dehydration and Cellulites (inflammation of the sub cutaneous tissue). He was emaciated and was brought to the hospital by his relatives, because he could not walk.
He was actually brought to us because the relatives had lost hope and wanted him to die in the hospital after being tested HIV positive. Our assessment of him and from what we obtained from his relatives was the fact that he was in abject poverty barely surviving on Carbohydrate Food. Since the relatives had already condemned him to death, I convinced them to sell his remaining useful property and bring the money for medication. He was resuscitated and placed on intravenous fluid and injections and multi-vitamins. Within a week, he made tremendous progress and we passed a Naso-Gastric Tube and fed him on Fortified Pap on regular basis. By the third week, the man that we were asked to sign his obituary was talking and strolling and was placed on Anti- Tuberculosis Treatment orally for three month as a trial. To cut the story short, he was discharged walking on his two legs and regaining some of his weight and was thoroughly counseled on how to live positively since he is HIV positive and could not afford Anti-Retroviral Drugs.
There were many similar cases I encountered then, although tested HIV positive, their main problem was lack of or inadequate source of livelihood. Many could have survived the HIV/AIDS and all its complications , had it been they were eating well and living in a good condition. Those of us in the Public Health Arena and Development Cycle will agree with me that, the component of poverty worsening the situation of People living with HIV/AIDS is not receiving the desired attention. There is much noise about provision of Anti-Retroviral Drugs without looking at poverty as a major factor fuelling HIV epidemic.
With respect to children that are living positively with HIV or are orphaned by HIV/AIDS, Malnutrition often begins at birth when poorly nourished HIV positive mothers give birth to underweight babies. Improper feeding and childcare practices contribute to the harm done by an inadequate diet, putting poor children at a permanent disadvantage. Malnourished children develop more slowly, enter school later and perform less well and Malnutrition is an underlying factor in more than half the deaths of children under five years. As we all know that even though there are other factors leading to Malnutrition, poverty takes the leading role.
With regard to prevention of HIV infection among those that are negative, no amount of campaign on how to prevent HIV/AIDS through electronic and print media and printing and distribution of Leaflets, Posters and Stickers and convening workshops and seminars and rallies will make any head way especially in impoverished Africa and Nigeria without addressing poverty. In most situations it is poverty and survival instinct that expose youth to endanger their life and hawk their body to the highest bidder and equally the older generation uses money to entice the youth in to sexual relationship, which is among the major routes of HIV spread.
The Millennium Development Goal One is talking about cutting in half the proportion of people living in extreme poverty and those suffering from hunger between 1990 and 2015. A poverty line of One Dollar per day is the yardstick of measuring poverty. Nigeria according to the Current Human Development Report, 70 % of its populace are living below poverty line. Although President Obasanjo has queried such yard stick but one does not need the report to know that poverty is living with us. Looking at the Millennium Development Goal Six, which aims at combating HIV/AIDS, Malaria and other diseases, the target is to reduce the prevalence of HIV infection among 15 – 24 years olds by 25 % by 2015.
The youth are the work force of our nation towards economic and social growth and the most vulnerable group in contracting HIV/AIDS and combining a strategy towards achieving MDG One and Six will be the only way out of the doldrums. At a recent forum in Kano during the commissioning of a reporting center of Voice of America, the Deputy Governor of the State was talking about AIDS ravaging many communities in Africa, as such something need to be done, like wise the United State Agency for International Development Director in Nigeria was mentioning that her agency has budgeted Millions of Dollars for the state alone to curb the menace. In many other places the story is the same, the international donor agencies are pumping money and technical support towards HIV/AIDS, while States and LGAs are becoming Oliver twist without doing anything on their own to respond to the saga by improving the poverty status of their populace.
In one of my articles on this page ‘Anti Retroviral Therapy in Nigeria, I talked about the Federal Government Programme on provision of Anti Retro viral drugs across the country and how the United State Government through Mr. Bush Presidential Emergency AIDS Relief come in to complement the effort of federal government by earmarking to reach out to about 350,000 people with drugs by 2009. Even though such kind gesture is commendable but never the less in trying to halt the spread of HIV/AIDS in Nigeria, poverty must be address both in the area of Prevention of the Disease among the vulnerable group and reducing the effect of the disease among those already infected.
We are very much aware of the fact that even without Antiretroviral drugs, a lot of People living with HIV/AIDS can survive if their poverty level can be improved and by treating Opportunistic Infections at the right time. The Nigeria’s HIV prevalence is at stand still since 1999, we are still fighting to reduce it from 5 % and there about and I am under no illusion that to halt the spread of HIV/AIDS in Nigeria is not only to provide Anti-Retro Viral Drugs and spend huge amount of resources in sponsoring workshops and production of print materials and payment for air time to feature someone who vividly lack the commitment and passion to talk to the youths about behavior change towards safer sex. While the very old generation that the same person belongs to , is the one abusing the chastity of youths and through that process spread the disease. To address poverty as it relates to HIV/AIDS prevention and control by States, LGAs and Federal Government, their International Partners and any other interested stakeholder will be the only sincere and genuine approach to halt the disease.
A comment on Insomnia
Few days ago someone sent a text message to this page complaining about his inability to sleep for the past one week, his desperation for a quick answer was exhibited by sending E-mail and later on called my line. We discoursed for about 10 minutes and my effort was to encourage him to relax and reduce stressful work, which at times is one of the major factors in leading to Insomnia. Apart from him, I believe many readers out there will benefit from an elaborate discussion on Insomnia and its remedy.
Sleep as we all know has a restorative function and it is important for conservation of energy as well as Growth, it allows one to rest and to be ready, refresh and alert for the next schedules. Insomnia is a sleep disorder and a condition of inadequate quantity or quality of sleep. For a sleep to be quantitative, that varies from person to person, but averagely one need to sleep at least on the average six hours to enable him/her cope physically and physiologically with challenges of life. With respect to the quality of sleep, it means, without much interruption and waking up frequently.
Insomnia may be a symptom of a depressive illnesses, anxiety disorder or other Psychiatric conditions, but more importantly in Nigeria and what we often seen around us, is the fact that many people that suffer Insomnia are not having any Psychiatric Illnesses, but rather it arises from increased life stress, many people become preoccupied with so many social issues with lack of sleep and at times fear in even trying to get to sleep. Such phenomenon establishes a vicious cycle of stress, fear and Insomnia which perpetuate the problem every day
When Insomnia results from a definitive Psychiatric illness, treatment should be directed towards the underlying condition through Counseling, Psychotherapy and Medication by taking Drugs. Sleep disturbance is a particularly distressing symptom of depressive illnesses in which case an Anti-Depressant Drug with sedative property will be very good in that kind of condition to be prescribed only at night.
That reminds me that a lot of people when diagnose with a Psychiatric illnesses or Psychological problems with Insomnia, while taking a detail history as to what cause such problem, one is bound to deduce that the problem is sequel to day to day happenings, social interaction and at times office work. People seem to be in a hurry to be rich or to actualize their dream very fast or to continue working throughout the day and even in the night and they will still come back home with a lot of residual work from the office. That scenario creates an unbalance mind, which makes it difficult for someone to sleep. And of course gradually one performance in the office will start declining due to exhaustion and lack of sleep.
I know of some one who takes sleeping tablets every day before going to bed, if not he will spend the rest of the night awake. Although Sleeping drugs are recommended in Insomnia but they are only for short term, like in acute stress, in case of separation between Lovers, Friends and Families or Bereavement. However such ingestion of drugs should not be for more than 3 weeks to avoid being dependent on the drugs before one sleep. Once dependency and Addiction is achieved, it will be a Herculean task for someone to come back to normalcy of sleeping without taking drugs
In another angle, Drugs are not the appropriate measures for an Insomnia that is chronic (suffering from the condition for long). The best approach to tackle Insomnia that is not due to Psychiatric illness is not for some one to be on Drugs but to review schedule of duty. It is discovered that a lot of people have a very terrible life of working all the time, seven days a week, even during break time, a lot of executive heads will order their food and eat while working. If you are a business man, civil servant, politician or a student about to write exams, it will be very good for your health to create time no matter how small , to be away from that work completely, one can stroll, chat with other people and also ensure regular exercise. Avoiding heavy meals, alcohol and caffeine containing drinks in the evening will help someone to cure Insomnia or not to have it at all. During weekends one can create some few hours to go for games such as Foot Ball and/or Basket Ball , many in door games that are available , Swimming , Golf , Horse riding and many more available that are within our domain .
Apart from the problem of Insomnia, Stress and Deep/chronic and Regular thoughts at times lead to release of so many chemical agents in the blood (Hormone) that can cause High Blood Pressure, increase in secretion of Hydrochloric Acid in the Stomach which lead to Stomach or Duodenal Ulcer (peptic) and at times such hormones can raise the Blood sugar level and lead to Secondary Diabetes Mellitus and decrease the weight of that person . One can see the advantage of ensuring that we shouldn’t overwork ourselves unnecessarily to ensure we don’t sleep at all without taking drugs.
Despite so many uncertainty in our dear country with respect to election both at the local and national level, the erratic light problem due to inefficiency of NEPA, problem with water supply and many schools and hospitals devoid of facilities and equipments and manpower and exorbitant price of Food Items and other sundry needs, I am of the opinion that one can put all these problems that appear insurmountable behind when retiring to bed and have a sound sleep without necessarily taking any drug. Let us concentrate on the present and improve our personal life by creating relaxation time despite our tight schedules and allow the future to take care of itself.
Dr Magashi is the Executive Director of Community Health and Research Initiative, Kano , Nigeria and can be reached at healthinteractive@hotmail.com
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