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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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New Minimum Wage: Before The Jubilation Starts

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If you are a tailor and you employ additional hands, you cannot pay them below N70,000. If you are a mother with a newborn child and you want to hire a housemaid to look after your child, you cannot pay the person below the approved minimum wage. It is not a maximum wage. It applies to all and sundry. “If you hire a driver or gateman, you cannot pay them below N70,000. So, I’m very delighted that this has been passed, and we now look forward to employers of labour improving on what has been set as a benchmark for all to follow.” This statement by the Senate President, Godswill Akpabio, is my greatest take on the issue of the newly approved minimum wage of N70,000. Meanwhile, one wishes to join other well-meaning citizens to congratulate the leaders of the Nigeria Labour Congress and the Trade Union Congress for their unrelenting efforts and commitment which resulted in the upward review of workers’ salary and the reduction in the term of negotiations from five years to three years.
From the revelation of the NLC President, Joe Ajaero, that the Labour leaders had to accept N70,000 when President Bola Tinubu threatened to increase the pump price of the Premium Motor Spirit (petrol) if he must pay the N250,000 minimum wage demanded by labour, it could be deciphered that the negotiation was not an easy task at all. But it is all good. He who fights and runs away, lives to fight another day. Now back to Akpabio’s comment. So, going forward, every worker in Nigeria – nanny, house keeper, gardener, cleaners, drivers, road sweepers and others are entitled to at least N70, 000 per month. This is actually plausible because over the years, the people in the lower cadres of employment, particularly those in the private sector have suffered neglect. You see a sales girl, a house keeper, who goes to work six days in a week and spends about 10 hours at work being paid N15,000 or N20,000 at the end of the month. How they survive on such paltry sum remains a wonder.
So, it is encouraging that the law makers stepped in to check this kind of slave labour. Whoever cannot pay the minimum wage should not want the services of the workers. But as the saying goes, talk is cheap; it is one thing to make the pronouncement and another to be convinced and ensure that it works. Are there plans by the law makers both at federal and state levels to ensure effective implementation of this? What are the plans by government to create employment for the citizens since following the senate’s rule will definitely throw many people out of job? Again, if by increasing the workers’ minimum wage from N30,000 to N70,000 (which we are sure that some states might not be able to pay), their financial responsibilities are also doubled, then what is the essence of the increase? Let us not talk about the inflation that will result from the salary increase because that is inevitable. Traders, businessmen/women and service providers will soon begin to demand citizens’ pound of flesh.
In my opinion article of June 22, 2023, I had canvassed that rather than the workers being paid thousands of Naira which cannot afford much, the nation’s economy should be fixed, the value of the Naira should be strengthened so that the salaries of workers will be more meaningful. That position has not changed. As far back as the year 2000 when some of us got employed, the minimum wage was N5,500 but then the Dollar exchange rate to the Naira was $1 to N85,98. Today, the exchange rate is officially N1,584 to a dollar. Unofficially, it could be as high as N1,600.00 or more to a Dollar, depending on your source. The value of the Nigerian currency has depreciated badly. The inflation rate keeps going up. And the worst hit is the worker who depends on his salary for all his bills – accommodation, health, electricity, gas, transportation, feeding, school fees, name it.
Time was, when accommodation was provided for government workers, car loans were given to certain levels of civil servants, staff buses and mass transit buses provided by the government were functional, education scholarships and other welfare packages for workers were easy to come by.  Today, this is a tall order. So, one would suggest that in addition to wage increase, the labour leaders and the government, both federal and states, should think of how to revive the Nigerian economy and improve the purchasing power of the Naira. Chief among the considerations in this line should be the revival of the nation’s refineries. It is a known fact which has been emphasised often and on by experts, economists and other well-meaning Nigerians that without the nation’s refineries being up and running, the cost of living, the cost of doing business in the country will continue to go up and the citizens will continue to suffer.
Indeed, it is baffling how an oil producing nation like Nigeria, with about 200 million population and an estimated 12.8 per cent annual demand and consumption of petroleum cannot boast of a single functional refinery.  Even the hope of having a succour in Dangote Refinery is being dashed by the feud between the Dangote group and the federal regulators. We continue to thrive in the business of exporting our God-given crude oil to other countries that may not be blessed with the natural resource, but have patriotic, selfless leaders, who consider the good of their countries above every other thing and have invested enormously on infrastructure like refineries to make lives better for their citizens. An analyst once likened what happens in Nigeria’s oil sector to a farmer who after planting, nurturing and harvesting his yams, takes them to a far away community to sell at a give away price. He later goes back to the same buyer who has cooked and pounded the yam to buy food to feed his family at an exorbitant price. Can this farmer be considered to be wise?
So, labour leaders should come up with ideas on how to have functional refineries in the country, dialogue with the government on best ways to implement those plans. They should constantly engage the authorities on this. They can give the government an ultimatum on when to get the agreed plans executed so that the issue of fuel importation will be a bygone in the country. Failure of the government to keep to the bargain, labour can take whatever legal action to press home their demands and they will definitely have the support of most Nigerians.  The issue of high cost of electricity should also be looked at. Nigerians are crying over high electricity tariff which gets increased every now and then even without informing the consumer. The recent increase of tariff for customers on Band A has dealt a heavy blow on many small, medium and even large-scale companies. Yet, these are the businesses that are expected to pay their workers a minimum of N70,000 monthly.
Our labour leaders should also, with the government, come up with measures to tackle the insecurity and unwarranted killings in our rural communities so that people that fled their lands can go back, farming activities will pick up and there will be sufficient food for the citizens. Some of the labour’s demands at the negotiation stage like tax holidays for employees both in the public and private sectors that earn less than N200,000 or $500 monthly; mass transit vehicles for all categories of the populace; an immediate review of the National Health Insurance Scheme to cover more Nigerians.  a petrol allowance for workers; a framework that will be geared towards reducing the cost of governance by 15 per cent in 2024 and 30 per cent by 2025 should be expeditiously addressed for the new minimum wage to impact positively on the workers’ lives.

Calista Ezeaku

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Opinion

Fatherhood: An Endangered Species?

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A father is a male parent or a male figure who plays a paternal role in a child’s life. He is typically the biological father, but can also be an adoptive father, stepfather, foster father, or a male guardian. A father is often seen as a source of guidance and direction, support and encouragement, love and nurturing, discipline, role modelling and mentorship, as well as  provision and protection. A father’s presence can have a profound impact on children’s lives, shaping their values, beliefs, and personalities. It  can also be a source of strength, comfort, and inspiration, helping the children navigate life’s challenges and celebrate  triumphs. Being a father is not just about biology; it is about being present, involved, and committed to a child’s well-being and development. Fathers come in many forms, and their roles and responsibilities can vary widely depending on cultural, social, and personal contexts.
A family without a father therefore, is like a ship without a captain, lost and drifting aimlessly. It is a family without a sense of security, stability, and guidance. It is a family where the children lack a male role model, emotional support, and a sense of identity. It is a family that is vulnerable, broken, and in need of healing. Like a garden without a gardener, such family would lack care and nourishment. Suffice it to say that  children  who grow up without a father figure in their life, remain  like a puzzle with a missing piece, incomplete and imperfect. They are not only more likely to suffer from low self-esteem and depression, but  are also more prone to anxiety and stress-related disorders. This deficiency traits haunt them  all through life to the point that their immediate environments, and society at large are not exonerated from devastating effects of their distorted lifestyles.    The rise of single-parent households and the increasing number of absent fathers have further exacerbated the problem.
This is why God did not consider it an error placing man to be called father, as the head of the family, to teach children valuable life skills, such as discipline, hard work, and responsibility, shaping their values and beliefs. But when a home actually has a male figure called father and yet the offsprings have nothing to show for it, it becomes a cause to worry about. Have we taken time to observe that we seem to be living in a generation that begats sons and daughters who act and behave like they have never felt the touch of a father? Does it really concern us that what once bothered on morals and integrity no longer count in our own time?  From the leaders down to the led, adults and infants, that sense of culture and homeliness which depict a fulfilled assignment of a father appears missing, leaving a question mark on the position of the supposed fatherly role in the life of a child. Today, we have grown-ups without initiatives, political thugs, whore mongers, criminals and corrupt individuals in high and low places who have lost consciousness of their self worth. To these ones, discipline and decorum are thrown to the winds.
It may not be out of place to state that changing social norms and cultural values, in addition to economic pressures and work-related stress have forced fathers to become disconnected from their families even when they are not miles away from home. These are underlying issues that need be addressed to create an environment conducive enough to get fathers involved. When fatherhood, a once revered and sacred institution, begins to gradually become an endangered species, the traditional family structure, that once served as the  backbone of society, starts crumbling. This trend has far-reaching consequences, affecting not only families but also society as a whole. The absence of fathers does not only have  a profound impact on children’s emotional and psychological well-being, its consequences  are far-reaching and devastating. We must recognise the importance of fathers in shaping their children’s mental health and take steps to ensure their involvement. Fatherhood is not just a biological tie; it is a nurturing and guiding force. Fathers provide stability, security, and love, essential for a child’s growth and development. We must acknowledge the significance of fathers and strive to preserve this vital institution.
The decline of fatherhood has both social and economic implications. Apart from homes being   prone  to experience poverty, and  children  less likely to have access to resources and opportunities, such as education and job training, it predisposes the society to crime, and social unrest, while registering  profound impact on community cohesion and social stability. This is why  it  warrants attention and action. Moreso, studies have shown that children without fathers are more likely to suffer from emotional and behavioural problems. They are also more prone to substance abuse and criminal behaviour. Fatherlessness is a ticking time bomb, threatening the very fabric of our society. We must take immediate action to address this crisis and restore the dignity of fatherhood. This can only be achieved by recognising the value of fathers and encouraging their involvement in family life.
More can still be achieved through initiatives that promote father-child bonding, such as parenting classes and support groups. We must also create opportunities for fathers to connect with their children, through activities and programmes that foster meaningful relationships. Fatherhood is not just a personal choice, but a social responsibility. Fathers have a duty to provide for their children, to protect them, and to teach them distinquish right from wrong. The revival of fatherhood requires a cultural shift. We must challenge traditional gender roles and stereotypes, recognising the importance of fathers in family life. We must also create opportunities for fathers to connect with their children, through activities and programmes that foster meaningful relationships.

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 Building Collapse: One Too Many

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The recent collapse  of Saint Academy Secondary School building in Jos, Plateau State, which claimed the lives of 22 persons among whom were innocent pupils and their teachers, has again brought to the fore, the menace of continuous building collapses in Nigeria. Sadly, that same Friday, a three-storey building still under construction in the students’ hostel area of the Nnamdi Azikiwe University at Ifite Awka, Anambra State, also crashed. Yet, following closely on the next morning, a two-storey building collapsed at Phase two, Site Two of the Kubwa area of Abuja, a former Al-Hilal Hotel that recently got reconstructed into residential quarters. Building collapse is becoming a daily phenomenon in Nigeria. If you live in a high-rise building, beware!
According to preliminary reports, the Saint Academy School tragedy is a sad out-come of a former bungalow which got converted into a two-storey building. The tragedy came at the ten-year anniversary of an earlier one in the same city of Jos when in September 2014, Abu Naima Primary and Secondary School, Bukuru, in Jos North LGA, had collapsed killing 30 pupils. As jarring and condemnable, the reccurrence of building collapses become, the regrettable losses have not elicited appropriate actions that would make them avoidable. Rather, after every incident, stakeholders react in routine knee-jerk rescue efforts, count human and material losses, wail and pour outward expressions of sympathy for victims, while some officials harp on the need to maintain guidelines on building standards, or even issue some mere threats that amount to no tangible solutions.
Though the history of building collapses is as old as Nigeria, its propensity has jumped in the last ten years, involving  especially new or on-going projects in Nigeria’s growimg mega cities, as developers in the face of poor building regulations try to reap inordinate profits from property boom. There has been virtually no one held culpable to deter perpetrators of unsafe building practices.On September 12, 2014, a six storey guest house within the Synagogue Church of All Nations at the Ikotun area of Lagos State, collapsed upon 300 victims leading to 116 deaths, among whom were 85 South Africans. The accident occurred despite forewarnings to church founder, Pastor TB Joshua, of observed structural defects. However, despite the Coroner’s Inquest inditing Pastor Joshua in the incident, he was never prosecuted.
On March 8, 2016 at Lekki, an on-going storey building being erected by the Lekki Worldwide Gardens collapsed killing 34 construction workers. This was despite allegations that Lagos State officials had issued a Stop Work Order on the construction site for contravening building approval terms. The developers were alleged to have recalcitrantly raised the building beyond the approved number of floors to the point of crashing. The crash on November 1, 2021, of another on-going construction of 21-storey Ikoyi Towers, which killed 44 persons, including the owner, Mr Femi Osibona, his personal assistant, Oyinye Enekwe and a US-based Nigerian business mogul and Managing Director of Foursquare Heights Ltd, Mr Wale Bob-Oseni, was also a consequence of adding more floors above the approved design levels. Disappointingly, these incidents and that at Banana Island, Lagos, of April 2023, ocurred despite projects being handled by supposed experts.
In recent times, Anambra State has been in the news more for building collapses than for anything else, though with lesser fatalities, but the crash on June 12, 2024, of an on-going five-storey Centenary Building in Onitsha, a building being erected by the Old Boys’ Association of Dennis Memorial Grammar School (DMGS) for its centenary anniversary, is worrisome given the calibre of professionals involved in the project. However, the collapse of Ochanja Market stalls in Onitsha, being constructed by Anambra State Government was the most disappointing of all, being handled by a regulator that should set the pace. Within weeks, another on-going construction of a two-storey market stalls collapsed on about 200 traders just last week, killing four at Eke Oyibo Market of Amawbia in the Awka metropolis, in close proximity of city planning officials.
Rivers state also is not left out in this ugly tally considering the sad crash of then on-going seven-storey building on November 23, 2018, at Woji Road, GRA Phase 2 of Port Harcourt, followed by the recent spike in on-going building collapses which include the February, 2023 crash of on-going two-storey building at Mbodo-Aluu, two separate callapses in June, 2023 of two-storey buildings at Okilton Drive and Ada-George areas of Port Harcourt, and the collapse weeks ago of a two-storey building at Okporo area of Rumuodara in Port Harcourt. While it is difficult to enumerate all incidents across the country, it is remarkable that the menace became worse within the last ten years. What may cause a building to collapse? Experts say, structural failures as a result of flaws in building design process, or improper project implementation, lead to collapse, but there is more to it from prevailing conditions in the country.
Though, present day developers use software tools to model building designs, the inability to interpret results with respect to erecting high rise buildings with currently available construction materials in the Nigerian market, raises questions of expertise. While many practitioners still resort to using structural formulation templates established from colonial days, when construction materials found in the Nigerian open markets were of standards specified in structural design handbooks, the use of prevailing poor materials for such designs creates vulnerability. Today, due to standards enforcement failures, the construction materials market is chaotic with regard to getting actual nominal dimensions of specific material quality, in view particularly of reinforcement rods.
For instance, what is nominally a 12mm rod in the market today, could range in real rod diameters from 10mm, 11mm to 11.5mm if one insists on taking actual measurements with a calliper, but a dealer would rate them small guage, medium gauge or full gauge 12mm rods, saying that size depends on manufacturer. But gauge should be gauge without intermediates because any reduction in diameter of rods leads to exponential reduction in cross-sectional area and shear strength. Also more unascertain is the alloy make-up which determines important metallurgical properties of rods, and one may seem out from the moon to ask a trader. The confusion cuts across all rod sizes, and buying materials has become an art in itself. For sawn woods, it is difficult to get any nominal dimension except one undertakes to saw customised dimensions, which is unusual. Also, some experts say current cement qualities are incomparable to former ones.
The consequence is that rebars configured according to specifications from handbook templates, but done with ‘Nigerian materials,’ may not bear the intended loads, or do so with very marginal factor of safety. In a country where budget has become a major decisive factor in construction, these considerations may be secondary in the absence of strict regulations even to ‘professional’ practitioners, let alone expecting some to employ qualified on-site supervisors. The solution to building collapses is that Nigeria should, no matter how difficult it is, revert to upholding general standards. The strict enforcement of the National Building Code of 2006 should be a good starting point. A regime in which concrete tests and certifications at every critical stage of construction are mandatorily required as pre-conditions for project continuation, should be strictly introduced, while the Standards Organisation of Nigeria should deploy materials test laboratories to certify and provide technical data of prevailing building materials to help operators make informed decisions.
Moreso, a situation where regulatory officials, city planners, supervisors and approval officers, allow themselves to be compromised should be discouraged by ensuring that prosecutions were conclusively pursued in every collapse to involve developers and culpable regulatory officials.

Joseph Nwankwor

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