Tag Archives: cold

The Cycle of Life Part 3

I could write and write about the many lives I knew that were cut short in their prime but I will complete the cycle with this last blog about one of my oldest friends. His name was Nabil. We probably met as babies but the first meeting I remember was when I was 15 years old. We had moved to London the summer before and were getting settled in still. My mama came home one day and announced we had been invited to have dinner the Ibrahim’s on Saturday. Who were they? I asked. She explained that they were old family friends. The parents were my grandparents’ friends and although their children were younger than my mother and siblings, they knew them well as children. I am told one of the kids had even stayed periodically with my grandparents in Lagos when they were going to school there. She told me that the oldest daughter had 2 sons, one my age and I was going to meet them.

Although we both lived in North London, it was quite a trek as there was no direct tube route and we had to go on 2 (or was it 3?) buses. By the time we got there, my nose, fingers and toes were frozen and all I wanted to do was curl up into a ball and sleep by a fire. I needn’t have worried. As soon as we stepped into their house, I felt my frozen cells begin to stir. It was always tropical in that house. Mum and Baba (the grandparents) like it very warm so there was never any danger of being cold once you got in there. I was introduced to the many adults, face after smiling face. It was like a mini-Northern Nigeria. All the warmth, the noise, everyone speaking Hausa. The boys were called down, Nabil and his little brother. They were instructed to take me upstairs until it was time for dinner. Although Nabil was friendly, he was definitely the quiet one. His little brother made up for it. He was very chatty, still pre-adolescent and full of excitement about life. Back then, he was quite small too. Very cute!

Nabil played us some music and told me about how they had only been in London for a year so were new to town too. He explained who was who in the family and we made general chitchat with his little brother telling us his fantastical half made up tales. We were in the same year of school and I was older by 2 months. By the time we got called down to dinner, we were friends. Over the delicious dinner cooked by Mum (his grandmother) and his mum, we talked some more. We exchanged numbers when I left. We stayed good friends over the years. We went to visit every so often and they made the trip across North London a few times too. We text occasionally in between visits. The next year, we talked about finishing year 11 and applying for colleges. I told him I was doing all the sciences and Maths because I would be applying to do Medicine. He said he wasn’t sure yet what he wanted to be so he was still thinking about which subjects to choose. We talked about where to go and I must have been convincing because I suggested for him to join me in Barnet College and he promised to consider it. He wrote down his address on a teddy bear notepad I had so I could sent him information when I had a confirmed place.

Common sense prevailed and he went to a college more local whilst I went to Barnet College. We went to see movies together and we even ate out at this stage, being all grown up at the ripe old age of 17 and 18 years. Every time we went out, he would insist on paying for everything and I would argue him down so we went halves. His little brother had grown into pre-adolescence by then and would irritate Nabil endlessly. His patience was great and he would repeatedly ask him to butt out of our conversations. I didn’t mind. I had a sister too and as the younger sister, I knew what it was like to be the little one. When we applied through UCAS for universities, he finally had a plan. He was going to study Maths. I was shocked. I mean, I was a straight A student and I got my A in Mathematics, an A* even in AS. I was no slouch when it came to it but to do a whole degree in Maths? I was agog! Why would anyone in their right minds do such a thing? He took my teasing in his stride. He said he didn’t have a profession in mind like I did and he knew he could use his generic Maths degree to do a wide range of things. I accepted this but I still thought him mad. He gave me that calm smile of his. ‘You’ll see’, he said.

As is the norm, we saw each other less when we went off to different universities. I went to Birmingham and he stayed in London. We probably saw each other once a year but when we did, it was like no time had passed at all. Ours was a very easy friendship. He would tell me about his ‘crazy’ Maths course. He seemed happy. I would tell him about Medicine and how much of it there was. How I realised more and more that what I knew was only a small fraction of how much I needed to know. He was openly impressed by how well I coped with it. His support and belief in my abilities were unwavering. Just like his friendship. I knew he was there somewhere should I ever need a friend. We text and Facebooked more than we spoke face to face. I can count the number of times we spoke on the phone in all the years.

Over the years, I would tease him gently about his girlfriend, or lack of. As the Fulani girl, I should have been more embarrassed to talk about such things but he was so shy about it. It became part of our friendships. I would needle him about ‘her’ and he would counter by asking me about my many boyfriends. I wasn’t shy about it. I had very little in the way of boyfriends but I told him of every encounter and how I preferred not having a boyfriend. He never admitted to any love interests but his brother was a more open book and I know there was somebody special at some point. He graduated and started an online sales platform. Next thing, he was talking about going back to Nigeria for his NYSC (mandatory youth service). He settled in Lagos. I happened to go the Lagos route once in his time there so I got to see him. He looked way too skinny and I was worried. As a newly-qualified doctor, I saw ill-health everywhere and was concerned he wasn’t sharing. He reassured me that he was fine. I didn’t need to doctor him. I believed him because youth corpers do tend to look the worse for wear during their year’s tenure.

The last time I saw Nabil was in Life Camp, Abuja in 2011. He happened to be visiting Abuja whilst I was there on a 10-day holiday. He was staying with a friend who brought him over. Again, I thought he was too skinny and he laughed it off. ‘Maybe I was always meant to be skinny like you’, he said. We chatted for an hour and he had to go. As we hugged goodbye, I felt how bony he had become. Life in Lagos was a hard one for a young man trying to start a business. My parting words were ‘You need to eat more. You should look after yourself better.’ His reply was a laugh and a ‘Yes doc!’ I stood at the door and waved until the car was out of sight. Not for a second did I imagine I was saying goodbye for the last time. The fuel subsidy crisis in Nigeria was the last thing we ever chatted online about. He became very involved in the demonstrations. I worried about his safety and he sent photos of himself and his friends at Lagos marches, looking happy and less skinny. He had found a cause to believe in. I was proud he was making a stand for a cause.

News that he was ill came out of the blue. I was in Yola, having taken a year out from working in the NHS to see the world. My mama got a call from one of his relatives saying that he was in hospital with a bleeding illness, cause still unknown. It was pretty serious and they were considering transferring him abroad as the healthcare available in Lagos was deemed inadequate. When my mother related the facts, I wanted to know more. What sort of bleeding? Was it related to a fever? Was Lassa fever the suspected cause? When my spoke to them again later, she was given more details. He had woken up that morning and told the friend he was living with that he wasn’t feeling too well. I think there was mention of a headache. He had been well the night before going to bed. His friend had gone with him to hospital and he either vomited or peed blood. The exact sequence is hazy but the gist of the story was that he had become sick rather quickly and what started out as an isolated bleed was now bleeding from multiple sources. He had been given a transfusion, we were told. He was conscious but seemed to be deteriorating.

When my mama related all of that news, I immediately thought the worst. When I burst into tears, she was alarmed. ‘He is alive,’ she said to me. ‘Don’t write him off.’ I tried to explain what I was thinking. I didn’t want to be a pessimist but unexplained severe generalised bleeding had a poor prognosis even with the best medical care. And he was not getting that. Not yet anyway. I had 2 professional experiences to draw on, both rather negative. My first experience of a patient with uncontrollable bleeding was in Malaysia on my medical elective in the 4th year of medical school. He was brought in by his heavily pregnant wife and a male relative to the A&E where I was working. He was very quickly diagnosed with Dengue Haemorrhagic fever. However, before any real treatment could be commenced, he went into cardiac arrest. With the medical students and his wife watching, the doctors performed CPR. It was horrific. He began to bleed from every orifice imaginable. His ears, nostrils, mouth. The blood was coming up the tube he had inserted into his lungs to ventilate him. The only part visible with no blood streaming out of it were his closed eyes. It was over as quickly as it began. It was obvious to everyone that he was far too ill to be saved. His wife was led away with the news.

The second experience was indirect. I was working in FMC Yola (Federal Medical Centre) and although Yola was ‘free’ from Lassa fever at the time, there were new cases being reported further south of the country. In fact, about 6 months before I had started working at FMC, there had been a patient with Lassa fever there and 2 of the doctors had contracted it from him. Unfortunately, 1 had died and the second had got to the Lassa Centre down south in time to be treated. He was one of the registrars on the paediatric team I was working with. So although he was okay, it seemed that mortality was quite high and only those who were diagnosed early and treated before they started actively started to haemorrhage (to bleed) were salvageable. Nabil’s story didn’t quite fit the bill because he had not complained of a fever and indeed had no fever in hospital. But it was my best guess with the facts I had and I feared the worst.

I pulled myself together eventually and prayed and waited with my mama. Next time we got an update, it was to say he was worse still, I suspect barely conscious at this stage. He was still bleeding despite all efforts and his parents were with him (they don’t live in Lagos). An air ambulance had been organised and he would be transferred abroad as soon as possible. We even heard he was being placed in the ambulance and I thought maybe there is some hope after all. That hope was short-lived. We got a call a few hours later to say that although his parents were in a flight to London, his air ambulance had never taken off. There were complications and unfortunately, he had not made it. I was so upset! All I could think is how his parents had no idea he had died and how they would have to make the return trip with that news weighing on them. To be honest, I have not asked them what happened exactly but it could only have been a terrible day.

I think the initial reaction of tears had taken the edge of my grief. I had started my grieving process before he was gone. I sat around in disbelief as my mama asked if I would be okay. As we made arrangements to go and visit his family, I could not stop thinking about how final death was. That was it for him, in this life anyway. I have no brothers so I whilst growing up, I found a handful of boys/young men to be my shining examples of decency in the male sex, my torch bearers when I felt dark about men in general. Nabil was one of them. Here was a gentle, calm, positive young man who believed in doing what was right, what was decent. He was respectful of God, his parents and our culture. He was a great friend and it was clear from the few times that I spent with him in the company of his family and friends that he was an all-round good guy. Losing Nabil was losing a little of the light in the darkness that sometimes surround men for me. Nabil was a good guy. Now he is no more. It took just over 2 days for a healthy young man in his mid-20s to sicken and die. Muslims would say it was time to go. I accept that but did it have to be such a horrible death? What did he ever do to deserve such an end? Why him?

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Mythical Malaria

My mama came back to London from a visit home to Nigeria in 2002 and felt feverish. Like most people where we come from, she thought it might perhaps be malaria but wasn’t unduely worried so decided to wait and see. On the Monday, she had the typical malaria vomit so she thought ‘I best get some antimalarials before it flattens me’. That evening, I came home from college, cooked dinner and waited for my mum to be home around 7pm as usual. 7pm came and went. Then 8pm which is when I realised something was up. I called her phone which went straight to voicemail. She did come home late sometimes especially on Mondays so I wasn’t all that worried but I did feel she shouldn’t work so hard.

She came in at 9pm irritation written all over her face. ‘What did she do this time?’ I asked, assuming it was the lady who had recently been promoted to the top position in their human rights NGO office who seemed to have gone power-mad and was intent on taking all the joy out of my mama’s life. My mum shook her head and over dinner told me about her ordeal in Whittington Hospital. Basically, she had tried to call her GP for an appointment and had no luck (what else would you expect in a London GP?). After work, she went straight to the closest A&E (Whittington Hospital) rightly thinking that she should not wait until her GP had an appointment for her to get treatment for malaria. Rookie that she was, she got straight to the point when asked what the matter was. I think I have malaria, she said. Pandemonium broke out. She was ushered in ahead of everyone else into a side room to isolate her. She had blood drawn before she could say ‘what’s up?’ and they were admitting her to a ward. When she finally got someone to stop and talk to her, she was informed that she would be going to the ward shortly and they would need at least 2 more blood samples off her as per the malaria protocol and she was being isolated. I wasn’t there but I know the look of amazement that my mama would have had.

Long story short, she refused to be admitted. She told them under no circumstances was her daughter going to be left alone all night, never mind I was 16 and had stayed the night alone before, in fact more than 1 night in a flat alone in Lagos at the age of 15 which was a damn sight more dangerous than Muswell Hill in London. Anyway, the doctors were beside themselves and there was a lot of hand wringing because malaria in UK is kind of a big deal and there are strict protocols and the Health Protection Agency red tape to jump through. My mama was not to be persuaded. She said she would be off within the hour and either they give her oral medication to go home with or she would walk out without. Either way, she was going to her baby. After a lot of negotiation, they gave the oral medications and she came home to tell me the story. The deal was that she had to go back in for her second blood test before work and for them to make sure she hadn’t developed cerebral malaria and died on them. Mama and I rolled around laughing at all this hoo-hah over something as simple as malaria.

So obviously we are not entirely looney and we know malaria is potentially serious and in a few cases even fatal despite medication. Since you, my readers, are not all medics like me I will explain the things that the media and doctors in the UK it seems don’t appreciate at first glance. There are 4 strains of malaria and 1 of these strains is the bad boy of malaria. It is called Plasmodium falciparum or P. falciparum. The millions of deaths from malaria are mostly due to this strain of malaria but actually most malaria is of the other 3 strains and in Nigeria, most people will get at least one bout of malaria in their lives. As children, we all got malaria several times. I think I was one of the lucky ones who only got 3 bouts of malaria in my life and the last time I had malaria was when I was in primary school (coming up to 20 years ago). Actually a lot of the malaria burden is probably not even malaria because we are so used to malaria that anyone who has a fever longer than a day and that is high enough to make them want to lie down, self-diagnoses malaria and trundles off to the chemist to get antimalarials (we don’t need prescriptions per se).

Now back to P. falciparum. This bad boy is the strain that causes cerebral malaria i.e. it likes to infect the brain and so makes you delirious and causes seizures and can rapidly kill you because the fever is so high causing all your body enzymes not to work (so your bodily processes a.k.a. your metabolism stops) and the seizures can be very hard to control so starve your brain of oxygen, turning it into mush and in most cases, killing you unless you get IV (intravenous) antimalarials and fluids very early on.

I do not make light of this malaria at all. I worked in FMC Yola for 4 months and I saw more children die from it than I would like to recall. It is terrible. But let’s put it into perspective. The Centres for Disease Control and Prevention (commonly known as CDC) has the following stats. Nigeria is one of the countries where malaria is endemic and transmission is rife, everywhere in the country. In 2012, there were 207 million individual cases of malaria reported worldwide and of them 627,000 died. That makes it a death rate of 0.3% – which is not as high as pneumonia or diarrhoeal illnesses. And that includes P. falciparum and the other 3 strains of malaria.

Now here are my own stats. Of all the cases I know that have died of malaria, they are mostly children or very old or people with other illnesses making them too weak to fight off malaria like those with sickle cell disease. Usually, these patients would have had the fever for longer than a week and their bodies would have tried to fight for so long and then got to the stage they have nothing left to fight it with so that by the time they are admitted, they are wasted, dehydrated and their body salts are so abnormal that this is what gives them seizures and kills them. Even those with the bad boy strain are usually completely fine if they get treatment in a timely fashion. And this treatment is highly effective for majority of cases and is just as effective given orally as long as the person is not vomiting copiously (which sadly does happen with malaria).

So I am writing this not only to debunk the knee-jerk panicked reaction of UK-trained and UK-based doctors with no first-hand experience of malaria but also to educate. Some strains of malaria can be as bad as the common cold. Some can be as bad as avian flu which although it is a ‘cold’ virus is more dangerous and needs treating. All malaria infection should ideally be treated even if it is a mild infection. People like me who lived a long time in a malaria endemic area develop resistance so malaria for us is much less of a big deal generally than for a malaria-naïve person. Also those of us with the sickle cell trait have extra protection against malaria. But for you who are not so lucky, you should absolutely take antimalarials when you travel to endemic areas. You should absolutely have mosquito repellents and in addition, wear long sleeves (or as Nigerian girls do have a light scarf wrapped over your neck, shoulders and arms) to prevent the persistent mozzies from nibbling on your ‘fresh’ blood. If you are white or even just a fair brown person, be extra careful as mozzies are attracted to fairer softer skin too. I would also sleep under a mosquito net.

Take it from me because although I am fairly immune to malaria I think, I am one of those ‘special’ people that give off the pheromones that drive the mozzies wild. It doesn’t matter if there is only 1 mozzy that gets into the room of 20 people and they are all in bikinis or even bare-chested, I will be the one bitten through my scarf and long skirt. I will be the one walking around scratching the large lumps left behind by each mozzy that found me. I will be the one waiting impatiently for my near-abscesses to heal weeks after I have come back to Birmingham. Le sigh!

Unfortunately despite your best efforts, you may still catch malaria. So if you have recently been to sub-Saharan Africa (or the other endemic regions, see CDC for more information) and you develop a fever high enough to give you the shakes (rigours), run to the doctor. If your bones and joints all begin to ache and all you want to do is sleep in addition to a fever even if mild, I would get tested. And definitely pack an overnight bag if you develop a fever then start to puke up your guts and the vomit is green has such a bitter taste it makes you want to puke again despite having nothing left. That is the malaria vomit (bilious vomiting in medical speak) and you will be admitted and isolated and the whole she-bang if you do seek medical advice which you should. In fact, pack a bag that will last at least 3 days and make sure you have books/a laptop/cards/smartphone/sketchpad or whatever else you need to keep your sanity because being in isolation is no fun. Also be prepared to be pricked several times for blood cultures. But it is for your sake that all this is being done so don’t hate on my fellow doctors ok? Stay safe!