#Ogbanje

#Based_On_A_True_Life_Story

Children's Emergency Room (CHER)
University of Benin Teaching Hospital
Friday, 09.06.17
12.52pm

"Doctor! Doctor! Emergency!" a voice kept wailing. "Please help me! My baby wan die oo! My baby oo!" She burst into tears for what seemed like a tenth time as she rushed in with her baby cradled in her arms.

The woman identified as Mrs Mercy Omoruyi, couldn't control herself. Tears ran down her face non-stop and her body was drenched in sweat. "Doctor, abeg! Save my baby oo!"

The paediatric senior registrar on duty in the unit, Dr Eseosa Osadiaye, swung into action. It was what they lived for down here.

In the woman's arms was a 3-year-old girl, Esohe Omoruyi, who was said to be the woman's only surviving child, after she had lost the previous three shortly after birth. The little girl was so pale she was almost white; her eyes had turned inwards and her body felt cold to the touch. Her pulse oximetry, which showed level of oxygen saturation in her blood, was in the early ninties.

Little Esohe was said to have developed fever two weeks ago. According to her mother, the baby's body was very hot. The fever was present at all times and was only temporarily relieved by syrup paracetamol. The baby was said to have convulsed multiple times at home, causing the mother to apply onions on the eyes, spoon in the mouth, and all what not on the child.

One look at little Esohe and my heart melted. The little girl was not just pale, she was also unusually thin. Her skin hung like plaster to her bones, her eyes sunken and her hair which were plaited, nay twisted, into grotesque bumps, lacked their usual colour. A brief physical examination revealed very dry mouth, capillary refill time greater than 4 seconds, reduced blood pressure and very little urine.

However, her skin shone brilliantly, like her mother also applied some local ointment on it, and the little girl smelled of Olive oil. Wait, could it be the cause of the shiny skin?

"My enemies no go succeed in Jesus name!" the child's mother started to scream, tears still running down her face as she did. "I cover my pikin with the blood of Jesus! Blood of Jesus, cover my pikin! My pikin no go die! Amen!"

With the little history of fever and multiple convulsions gotten from the mother, a few things were certain at that point: the child was most likely having an infectious process going on in her which had caused those signs. And for a child of that age in our environment, two major things stuck out in mind: severe malaria and meningitis.

But regardless of that, another thing was certain: this child was dehydrated and malnourished too. Once she was weighed, I gasped at the result: 8kg.

What?! I was shocked.

For a normal child of 3 years, the expected weight was somewhere between 14-15kg. I was moved. 8kg represented less than 60% of the child's expected weight for age. In fact, 8kg was the weight you'd expect for a 7-month-old child, but we were talking of a 3-year-old!

The child was also malnourished and even dehydrated.

And as common as it seemed, I hated seeing malnourished children. It was something that always tore my heart to shreds because malnutrition was often regarded as a "silent killer". Besides that, malnutrition was associated with a host of other diseases that were fatal in children less than five years old, the commonest link being diarrhoea.

As Dr Osadiaye instituted quick management, the questions started to rain down on Mrs Omoruyi. "Since the two weeks of this fever, what else did you do?"

The woman began to stutter. "My husband say make we carry am go see one Baba like that," she said.

What? I already knew what she meant by "Baba". They had gone to see a native doctor.

Dr Osadiaye was inscrutable. "Then what?"

"We stay pass one week for the Baba place, and when baby body still come dey hot, we come carry am go one church like that on Monday."

I was so livid I nearly pulled out my hair. Madam, you said what?! Ibu onye ara?

"Wetin the Baba talk say na im dey do your pikin," I asked.

The woman stared at me briefly. "He talk say na Ogbanje."

Ogbanje? Really?

Was I surprised? No way.

This was the problem we often faced. Parents only came to the hospital as a last resort, not as the first. And guess what? In the minds of some of them, a native doctor and a pastor were more knowledgeable in health matters than doctors; to some others, the hospital was far costlier. However, no matter how you sliced it, you would find out that they spent considerably more at those places than at the hospital.

Once Dr Osadiaye examined the child, the clinical signs of severe malaria were all over the place. There was already impaired consciousness, but in addition the child was also in prostration, fast breathing (respiratory distress), and had cold clammy extremities. As I ran around taking blood samples for lab tests, Dr Osadiaye started to educate the woman based on the most likely diagnosis of severe malaria.

There was one thing many people in our society didn't know. Malaria was one disease that many around here regarded as common and easily treatable. Now while this was true, fact was that malaria was and still is a killer disease, especially among children less than 5 years old. About 545,000 children die annually from malaria around the world, that's an average of one death every 30 seconds. 85% of them were from Africa.

Out of the 125 million people worldwide that suffered malaria every year, 90% of them were from sub-Saharan Africa and 25% of all were from Nigeria alone. Malaria was so serious it killed in one year what HIV/AIDS would kill in 15 years.

"My enemies no go succeed!" Mrs Omoruyi kept crying. "Them wan kee my pikin."

"Nobody wan kee your pikin, ma," I said, fighting back the anger welling up deep inside me.

"It's your crazy behavior that's the problem here," Dr Osadiaye added. "What prevented you from bringing this child to the hospital since?"

The woman couldn't move a limb.

Dr Osadiaye then explained to her the severity of malaria, which obviously she didn't know. Hell, many Nigerians still don't.

Severe malaria was a fatal disease, more fatal than anyone thought. Obviously, the woman had acted very stupidly, but it was a sort of stupidity that was common among Nigerian parents of middle and low class - and which was very associated with poverty.

The delay in bringing the child to the hospital resulted in the increased severity. According to the mother, the oily skin was due to the excessive olive oil used by the church pastor to exorcise the "demons" troubling the child.

Inukwa.

As the woman kept crying, I had to move to calm her down. "Your baby will not die," I said. "We are already giving her the necessary drugs."

As severe as malaria was, there were reliable drugs for managing it and intravenous Artesunate was always our first choice. Other drugs included Quinine and Artemether.

In the case of that child, nutritional rehabilitation was also needed considering she was marasmic (very low weight due to malnutrition). And for middle and low income families, we advised that she put grounded crayfish or groundnut into her pap, alongside palm oil and leafy vegetables to make up for the macro and micro nutritional deficiencies. In addition, we needed to correct the dehydration and we initiated the appropriate protocol.

"Thank you, Doctor," she started to say. "God go bless una well well." She sniffed, fighting back tears.

I smiled. "Amen. But don't try that again with your child. It was a terrible thing you did. When next your child is sick, bring her to the hospital immediately."

Children are so precious they are God's greatest gift to mankind. Don't joke with them, maka m imeru mmadu ahu. 😂 😂

# Impossibility is nothing. Just believe

DISCLAIMER
This may be a true-life story, but the names, characters, places, and incidents either are the product of the author's imaginations or are used fictitiously. Any resemblance to actual persons, living or dead, events, or locales is entirely coincidental.



#ChukwuGozieUnuNiile

~ Caséy Amaefule©