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Challenges Of Paediatric Surgery In Nigeria

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According to the United Nations Children’s Fund (UNICEF), Nigeria is a ‘country of the young’ with 92 million of its over 200 million population under the age of 15 years. Also, according to Professor of Paediatric Surgery at the University of Lagos, and former Chief Medical Director (CMD) of University of Lagos Teaching Hospital (LUTH), Prof Christopher Bode, the number of children under 5 years old in Nigeria are over 30 million, with about 7 million new babies being born yearly. Prof Bode was the keynote speaker at the second edition of memorial lecture, held last week at the University of Port Harcourt, in honour of one of the pioneers of paediatric surgery practice in Nigeria, late Dr. Melford Graham-Douglas.
According to him, paediatric medicine is the medical care of children, a broad name for treatments for those from zero to 15 years of age, of whom Prof Bode observed are tender and voiceless, because they mostly can’t speak for themselves, depending on their parents for important lifecare decisions. Paediatric surgery which deals with surgical cares, mostly of birth defects in babies, demands the utmost skilled personnel, equipment and specialist handling, considering the tenderness of babies. Since the introduction of paediatric surgery in Nigeria, child-care professionals have continued to champion the awareness that children need specialised healthcare and infrastructure more customised to their needs as distinct from general medical practice.
Despite the achievements made so far in Nigeria in reducing infant mortality rates from previously untreatable birth defects, thanks to the foresightedness of pioneer paediatric surgeons like the late Dr Melford Graham-Douglas, enormous challenges still face the discipline from achieving its full objectives.As part of the general challenges of the Nigeria healthcare system, health screenings for disorders are mostly relegated out of ignorance, to the effect that paediatric cases requiring earlier surgeries are presented late, while most children are unable to communicate their health challenges. Where emergencies occur, paediatric surgeons have had to wait endlessly, for the general surgeons to free-up adult theatres before they could exercise efforts to rescew babies in critical conditions.
Considering that children are different in size and physiology, their cases become more delicate. Their body surface to mass ratios are much higher than in adults, that they dissipate body heat faster in normal ambient temperatures, and easily catch cold in the cold conditions of adult surgical theatres. Warmer surgical theatres designed and dedicated for children are always needed or they easily succumb to life-treathening hypothermia. Basic amenities are also needed to transport children in warm ambulances, especially babies, from hospitals of first call, to the centre of definite care.Paediatric surgeons also need to monitor children’s blood levels with specialist care because children have very low blood volumes that a minor loss could tip the balance between life and death. Due to anatomic differences from adults, children need special anaesthesia to undergo successful surgeries, and careful drug calculations to cope with their tender metabolic systems, their airways being so narrow, many routine anaestetic steps in adults are unsuitable for newborns and infants.
Drugs and the amount of fluid infusion to be administered to a child must be carefully calculated to conform with body weight, and in isothermic conditions. These are reasons paediatric surgery is such a speciality area that requires the skills set and infrastructure it deserves. It has been a huge challenge to practitioners who have had to work in poorly equipped environments. Paediatric surgery units in Nigeria should therefore be provided with neonatal intensive care units (NICUs) and paediatric intensive care units (PICUs) to ensure adequate post-surgery cares for babies and children, in addition to providing exracorporeal membrane oxygenation (ECMO) machines.Prof Bode however regrets that low man power remains a challenge in the field. According to him, in a survey conducted in Nigeria, about 2.9 million Nigerian children live with surgically correctable conditions, meanwhile there are just 38 treatment centres and only 115 paediatric surgeons in the country, some of whom have left for greener pastures, leaving a workload of about 25,000 patients per surgeon. There are only 22 professors of paediatric surgery to train needed personnel. There is therefore a need to create significant incentives that reverse the exodus of skills.
The labours of specialist surgeons like the late Dr Melford Graham-Douglas, who worked tirelessly to save lives remain commendable and they need being immortalised as an encouragement to others. There is need to celebrate those who served humanity selflessly and bequeathed a legacy of patriotism and hardwork.Late Dr Melford Graham-Douglas was the first African surgeon under the British Technical Assistance Scheme. He was a fellow of the British Association of Paediatric Surgeons, a fellow of the Royal College of Surgeons of Edinburg and England and a fellow of the American College of Surgeons. He was the first registrar of the Nigerian Medical Council, was among the founding fathers of the University of Lagos, as well as being a council member of the universities of Ibadan and Port Harcourt, respectively. Back home, he served the Rivers State Ministry of Health as permanent secretary who laid the foundation of health infrastructure in the state. He was honoured with the Order of the Federal Republic (OFR).
An icon of the Orubibi Group of Houses in Abonnema, the University of Port Harcourt honours late Dr Melford Graham-Douglas with a Professorial Chair in Paediatric Surgery at the university’s College of Health Sciences, in recognition of his contributions to humanity. The chair, currently occupied by Prof Amabra Dodiyi-Manuel, is dedicated to research and development in paediatric surgery.Government should build upon the foundations established by men like late Dt Graham-Douglas to equip the College of Health Sciences of the great University of Port Harcourt, with state of the art facilities in paediatric surgery, as a centre of reference within the South-South region. As it stands today, there is no significant paediatric surgery centre in the region. The management of UNIPORT should engage both federal, state and regional stakeholders to ensure this becomes a reality.

By: Joseph Nwankwo

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Dimensions To Nigeria’s Food Crisis

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Going by statements credited to Nigeria’s Vice President, Senator Kashim Shettima, that “some people are working to undermine the efforts of the President Bola Tinubu administration”, especially with regard to the rapidly rising costs of food items across the country, one begins to worry if the trend of economic difficulties that began since 2015, will ever be reversed, or at least be halted. 2015 was the year the All Progressives Congress party took over governance in Nigeria, led by former President Muhammadu Buhari.According to national media reports, Vice President Shettima had used the opportunity at a conference on Public Wealth Management which held in Abuja, to reveal the discovery of “32 illegal routes,” in Illela Local Government Area (LGA) of Sokoto state, through which smugglers freight commodities out of the country. The VP also disclosed that “45 trucks loaded with maize were intercepted while making their way to neighbouring countries at midnight on Sunday.”
While the discovery of 32 smuggling routes in one Local Government Area, (LGA) of Sokoto state alone is startling, it is disheartening to realise that the state has five other border LGAs where similar things happen – Gudu, Tangaza, Gada, Sabon Birni and Isa – and worse still, considering that apart from Sokoto, states like Kebbi, Zamfara, Katsina, Jigawa, Yobe and Borno all lie along Nigeria’s porous 1,608km border with Niger. The interception of 45 trucks in just a night in one LGA, makes unimaginable the enormity of the number of truckloads of food items leaving this country daily.The unpatriotic priority of supplying Niger Republic, even at the risk of smuggling across terrorist-infested borders, against pressing domestic demands, is another reason for concern, and puts to scrutiny the efficiency and patriotism of our border control personnel towards implementing extant government policies. How long has this been going on, or was it a recent development?
Or was it the result of calculated distraction from political antagonists to frustrate the present administration, as the VP tried to paint it? His picture looks appealing when correlated with the recent spike in the price of cement, especially. But how come it was the vice president who stole the show of making the revelation public, instead of the intercepting agencies? It is expected that the federal agencies whose duty it is to secure borders should have been proud to parade and announce such achievements to showcase the essence of their establishment. And from Mr Vice President, who went short of naming the culprits, but rather alluded to “knowing the consequences of revealing the masquerade”, many would have preferred he damned those consequences by revealing particulars, otherwise many are tempted to perceive him as merely propagandising facts in the face of a national crisis.
However, while pondering the above worries, it would be worthwhile to review the changing political and economic landscapes inside and outside Nigeria since 2015, to find out factors that might have been at play. Hitherto, Nigeria had enjoyed free, cross-border movements of goods and persons with Cameroon, Chad and with its Economic Community of West African States (ECOWAS) neighbours up until May 2015, when President Muhammadu Buhari came to power. These movements supported transverse trades up to Mali, Burkina Faso, Central African Republic and as far as Lybia. By July of 2015 the Buhari’s administration, poised to enforce home-grown production, had imposed cross-border restrictions, a situation that became more stringent following the COVID-19 pandemic lock-downs of 2020.
On the other hand, nationalist uprising in eastern Cameroon from 2016 culminated to the 2019 Ambazonian separatist movement that ever since, pitched the ‘amba boys’ in gorilla warfare with Cameroonian authorities. Buhari’s government corresponded with Cameroon to tighten border restrictions on both sides. For every step of restriction, commodity prices responded in increase, both in Nigeria and across the borders, increasing the inducement for smuggling, no thanks to porous borders and the usual “pay and pass” atmosphere. Border bribes get higher with restrictions, reflecting on costs as goods flow across. Nigeria, being a huge source of farm products, and for a long time a source of subsidised petroleum products, fed scarcities that intensified many miles off its borders. Accompanying and aiding smuggling was heightened islamists influx into Nigeria from the Sahel.
Greater numbers of maraudering Islamist gangs from Mali, Niger, Chad and the Central African Republic, acting either criminally on their own, or on brotherhood solidarities in the ethno-religious, farmers-herders or political conflicts in Nigeria, attack and plunder agricultural settlements. It has degenerated to current general insecurity, spate of kidnappings, and rapidly rising food prices. The spread of inflation across border was aided by the coup of August 18, 2020 in Mali, to which ECOWAS responded with economic sanctions. Mali with no direct border with Nigeria, has short connections through south-western Niger Republic. The overall game changer dawned since February 24, 2022 with Russia’s invasion of Ukraine, followed by October last year’s out-break of Israel vs Hamas war in the Middle East. Ever since, global supply chains of grains, energy and raw materials have remained disrupted, shooting up everything from transportation costs to the value of foreign currencies.
Subsidy removal shocks on Nigeria’s poor transportation infrastructure, a sector daily threatened by insecurity, meant it was becoming more expensive to businesses in the north, compared to shorter cross-border routes which, in addition present prospects of higher gains. This becomes more obvious considering that the distance from Gboko in Benue to Bamenda in Cameroon is 443.7 Km, while from same Gboko to Lagos it is 795.9 Km, and 538.5 Km to Port Harcourt. Yola in Adamawa to Touruo in Cameroon is 229.5 Km, but it is 879.1 Km to Calabar and a staggering 1,327.4 Km to Lagos. Meanwhile, Illela in Sokoto can be crossed on bike or donkey into Birnin Konni, 5Km into Niger Republic, while the distance from Kano to Maradi in Niger is 268.2 Km, Kano to Abuja, 432 Km, and 992.2 Km to Lagos. Birnin Kebbi in Nigeria is 395.6 Km to Niger’s capital, Niamey, while being 658.4 Km off Nigeria’s, Abuja. In fact, smugglers utilise shorter segments, like in case of Illela to Konni, for higher round-trips.
According to reports, the amount of cross-border trades currently going-on across the Niger border is to the tune of N13 billion weekly, on items ranging from kusus, local flour, onions, tomatoes, pepper, potatoes, millet, maize, rice, jewelries to livestock, from which Nigeria losses revenues. The juntas in Niamey and Bamako, for all their militantness and recent pull-out from ECOWAS, let the illicit trades thrive. All these put together, it is easy to figure out the underlying factors to Nigeria’s economic woes, and to relate patterns with insecurity – Nigeria’s very porous borders have become more attractive in the face of rising haulage costs, as much as agro-production outputs are declining due to insecurity.The situation therefore calls for drastic measures to curb insecurity, transportation costs and smuggling, while massively investing in production. Even if it takes the tactics of ancient cities whose domains had to be walled-off with fortifications to achieve internal control and protection.
Yes, the flux across Nigeria’s 1,608 Km porous border with Niger Republic can, and should be checked with perimeter fortifications punctuated with approved access stations, and manned with surveillance technologies. Nigeria should also do same along its 809 Km border with Benin Republic and the 1,975 Km with Cameroon. With security concerns now gulping over N3.2 trillion in the 2024 national budget, a trillion Naira out of that bulk would fortify more than one flank of the borders to give our security personnel, beset by attack-and-withdrawal terrorists, a better chance at ending insecurity, and the border agencies, no excuses in discharging duties.

Joseph Nwankwo

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Strengthening African Value System

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Africans are known over the years for sharing cherished values. Some of the values are but not limited to: hospitality, brotherliness and unity. These and some other features drive communalism for which Africans are loved. Rugged individualism is alien to traditional Africans but can be found among those influenced by the Western culture. “The highest form of worship is the worship of unselfish Christian, the highest form of praise is the sound of consecrated feet seeking out the lost and helpless”, according to Billy Graham, a 21st century foremost Evangelist and hero of the Christian faith who was at forefront of the titanic struggles for the soul of Christianity. The amount of influence a person has  on  his neighbour, family and society is the result of the positive impact he or she made  on them. Life is all about people we positively impacted and not how much wealth we have inordinately acquired. It is not how much money one has in his or her bank account, it is not the fleet of cars a person is able to acquire, it is not  landed property a person has neither is it the number of children nor the fame a person has achieved nor is it academic degrees.
While these are good if legitimately acquired, they are not what life really is. The very essence of life is captured in the multi-million dollar question Jesus asked, for which every person is required to honestly, conscientiously and thoughtfully give answer to. And the question is: What shall it profit a person if he gains the whole world and loses his or her soul? What shall a person give in exchange of his or her soul? Similarly, the lyrics of a stanza of a popular hymn, titled “Fading Away like the stars in the morning” says: Only the truth that in life we have spoken; Only the seed that on earth we have sown; These shall pass on when we are forgotten…..The selfish, self-centred and greedy have never found true peace of mind and joy because they are never satisfied. They always crave for more even at the expense of others’ entitlements.
John L. Mason in one of his best seller leadership nuggets said, “What you give lives. A good way to judge a man is by what he says. A better way is by what he does. The best way is by what he gives”. “ The secret to living”, says Charles Spurgeon, “is giving”.Whatever God does in your life is not so you can keep it to yourself. He wants you to give to others.  According to Eleanor Roosevelt, “When you cease to make a contribution, you begin to die. Giving is always the thermometer of our life. Getters don’t get happiness. Givers get it. When you live for another, it is the best way to live for yourself”. Bible Saint Paul told his spiritual son, Timothy, “Godliness with contentment is great gain. For we brought nothing into this world, and it is certain we can carry nothing out” (1 Timothy 6: 6, 7). This wise saying of Paul further underscores the folly of building one’s life on materialism.
A Swiss’ words on marble say: A greedy person and a pauper are practically one in the same. G. D. Bordmen said, “The law of the harvest is to reap more than you sow”. It is a truism that no person leaves this world with a piece of anything he or she has acquired. This is because the immaterial world does not condone materialism. Materials are earthly so have no place in the spiritual realm or the realm of the supernatural. This why great men live their lives for God and humanity. Philanthropy and human-centred services are the bedrock of life. Social application of the gospel gives the word a human face. Great men that have passed on, placed value and emphasis on building or positively impacting humanity than embarking on self centred activities which are counter-productive and meaningless.After repenting from materialism and sin dominated life, the Bible King Solomon wrote in the book of Ecclesiastes: I have seen all the works that are done under the sun, and behold all is vanity and vexation of spirit (1: 14). I made me great works; I builded me houses, I planted me vineyards:
I made me gardens and orchards, and I planted trees in them of all kind of fruits: I made me pools of water, to water therewith the wood that bringeth forth trees. I got me servants and maidens and had servants born in my house; also I had great possessions of great and small cattle above all that were in Jerusalem before me: I gathered me also silver and gold and the peculiar treasure of kings and of the provinces; I gat me men singers and women singers…so I was great and increased more than all that were before me in Jerusalem…And whatsoever mine eyes desired I kept not from them, I withheld not my heart from any joy, for my heart rejoiced in all my labour…Then I looked on all the works that my hand had wrought, and the labour that I had laboured to do: and, behold, all was vanity and vexation of spirit, and there was no profit under the sun (2: 4—11).
Secular humanists do not see life from the perspective of making others happy because most of them take delight in the pains and suffering of others. They rather believe in living for themselves and families even if it means denying others what belongs to them and “robbing Peter to pay Paul”. Those who are spiritually minded and eternity-conscious are service driven and philanthropic. Sadism is a function of greed and selfishness. Not feeling the pain of the whip on someone else’s back, is the height of callousness.  If rich people, especially those holding public offices, should invest the public money stashed away in foreign banks in the less privileged in our society, the untold hardship people are passing through will be greatly cushioned.  A candle loses nothing lighting others. The rich should not be high minded, rather they should be challenged by the humanitarian services of others.No person takes anything out of this world at death, believe it or not.

Igbiki Benibo

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Nigeria And Echoes Of Socrates On Democracy 

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Socrates (469-399BC), the Greek philosopher and political sage of Athenian descent, was critical of the ways in which his fellow Athenians operated under the then novel  concept, ‘democracy’. Though Socrates was not  necessarily critical of democracy itself, he was worried about its likely outcomes in the future. His criticism indicated that he wanted this mode of decision making and governance to be operated with utmost care. Addressing his audience on the then novel concept, Socrates said thus inter alia: “Thieves and fraudsters will want important government functions, and democracy will give it to them, when thieves and fraudsters finally democratically take authority because criminals and evil doers want power, there will be worse dictatorship than in the time of any monarchy or oligarchy”.
The above brief deposition on democracy is segmented into four parts that yield to critical analysis. The segments are (1) “Thieves and fraudsters will want important government functions”; (2) “democracy will give it to them”. (3) “When they finally democratically take authority because criminals and evil doers want power”; (4) “There will be worse dictatorship than in the time of any monarchy and oligarchy”.   This piece interrogates contemporary Nigeria with special reference to  the essence of democracy and power politics from the prism of these segments of Socrates’ perception of democracy. It is with trepidation that one reflects on the above centuries’ old saying vis-a-vis the reality of contemporary Nigeria with special reference to the Fourth Republic. With the prophetic exactitude of the averment for Nigeria, one could have sworn that Socrates looked into a giant celestial crystal ball for the then non-existent most populous nation in negrodom, perched on the coast of the Gulf of Guinea.
Five months into office as President of the Senate of the Federal Republic of Nigeria, Evan Enwerem was removed from office as a result of duplicity of names, fraudulent educational records, concealment of criminal records, etc. It was also during the same period that “Toronto” entered the lexicon of Nigerian politics, not as the name of a major city in a country in North America but as euphemism for certificate forgery. Incidentally and interestingly, the political head of Salisu Buhari rolled in that episode. He was later pardoned and reintegrated into the political fold through a political appointment. Today, public office holders who can, with every sense of responsibility, be justifiably referred to as “thieves and fraudsters” have finally taken authority. How else do we describe those with forged educational and birth certificates other than “thieves”?
Or how else do we describe those who deliberately manipulated the democratic process by hacking into voting machines and altering voting figures other than “fraudsters”? And how do you describe those who brazenly and audaciously grabbed, snatched and ran away with ballot papers and boxes into the “bush” other than “criminals and evil doers”?   Socrates’ crystal ball certainly zeroed in on the futuristic Nigeria and we are all living in that future because all of the above have happened in Nigeria during the 25 years of the Fourth Republic. Hitherto esteemed eggheads have tainted the Ivory Tower by their inordinate quest for ignominious pecks;  the judge’s gavel has morphed into auctioneer’s hammer thereby enfeebling the justice delivery system, the last bastion of hope of the citizen against the Leviathan. The moral fabric of the nation has been swept under the carpet and stench of technicalities.
Sprouting at the heels of the Hobbesian state of nature, when “life was nasty, brutish and short”, monarchies and oligarchies were  characterised with unbridled use of power that degenerated into dictatorship. It is, therefore, very worrisome to note that Socrates envisaged that  “there will be worse dictatorship than in the time of any monarchy or oligarchy”. This is where the Socrates’ averment under reference becomes ominous.   The trending phrase of defiance “Go to court”, is reflective of a compromised judiciary and the hopelessness of the concept of rule of law in the Nigerian social milieu. How this will pan out regarding social order vis-a-vis lawlessness remains a subject of serious concern for social critiques. Given the proliferation of assault rifles in every nook and cranny of Nigeria, what is very likely in the not-too-distant future is that when the seed of disregard for law and order, which we have sown, germinates, government will depart from the democratic ideals of governance.
They will, inevitably, degenerate into dictatorship that may be worse than what obtained during the immediate post-Hobbesian monarchies and oligarchies; this will be necessitated by the need for government to use sufficient force to contain the lawlessness in the land and the resultant threat to peace. Political Science 101 teaches that “Power corrupts and absolute power corrupts absolutely”.  At this point, there will be justification for the utilisation of extreme force to deal with the dire realities of the extreme situation. There and then, there will be absolute power that will birth dictatorship worse than what obtained “in the time of any monarchy or oligarchy”. No wonder it is said that since Socrates, no one has said anything new.  At the point of the groundswell crises implied above and with powers reminiscent of the absolute powers associated with post-Hobbesian monarchies and oligarchies, Nigerian political leaders are acting like drunken captains of a sinking ship.
With the judicial delivery system sweeping the moral fabric of the nation under the filthy and nauseating carpets of technicalities, Nigeria is consistently and insidiously slipping down a slippery economic slope; and will speedily slide down the precipice of disintegration, if care is not taken. Socrates was right: democracy has given “thieves and fraudsters important government functions” in Nigeria because “criminals and evil doers” adorned in tainted wigs and gowns “want (financial) power”; and now, “dictatorship worse than in the time of any monarchy or oligarchy” is afoot. The tragedy is that, dazed in the hoodwink of religious bigotry, regionalism and ethnocentrism, Nigerians are stupefied and confused; and they are watching helplessly while morally stinking and sticky-fingered scoundrels in every sector of the economy  are sinking the ship of the state. God help us all.

Jason Osai
Prof. Osai is of Rivers State University, Port Harcourt.

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