January 26, 2012
Agnes – Ovuoba
When we arrived at Ephuenyim Clinic in the afternoon of the 26th, we were told that they had received word of a woman bleeding Ovuoba following female circumcision. We had been at Ephuenyim attending to patients earlier in the day and just returned from Offia Oji health center on the way back to Abakaliki. We went with Steven from the health center in our vehicle to bring the woman to the health center. Apparently they hesitated to bring her to the health center as Female Circumcision is illegal in Ebonyi State. On the way, passing through Okpanko we met a private car. The family had arranged a vehicle.
Supported by her brother and mother, Agnes walked with difficulty from the car to the clinic room. She is tall and skinny girl of 20. She was very pale, very weak, and clearly in agony. Dr. Fatoba examined her carefully and determined that she had lost too much blood. According to the family she had bled for more than two days in the house. Dr. Fatoba decided that she needed blood transfusion. We took a blood sample, and Chinedu, the head of Ephueniyim health center, took the sample to a lab in Abakaliki in the evening. Early the next day morning we secured the blood and brought it back to Ephuenyim, and Dr. Fatoba set up the blood transfusion. The same afternoon she looked much better. Agnes stayed at Ephuenyim health center for more than a week before she was well enough to be discharged.
The practice of FGM remains prevalent in Ebonyi State, and in our project area it continues in many villages. The normal time for the circumcision is when the girl is around twelve or thirteen, as part of a ritual when the girl is initiated into womanhood. This is because it’s the beginning of puberty, and they want to make sure that the females have their clitoris cut before the age when they can become sexually active. Another reason is that the arteries in the genital area is not yet fully developed at thirteen, so the risk of heavy bleeding after the cutting is less. To perform the circumcision at Agnes’ age of 20, is much more risky as there are now major arteries in the genital area.
When Agnes parents swore that they did not know that she was going for circumcision, we did not believe them. Often it’s the parents who make sure their daughters are circumcised. But Agnes corroborated the story. She said she did it because her friends at school were laughing at her, and making fun of her because she had not been cut. The woman who came to perform the operation, was not a local, she explained. She was a health worker from another community. In fact, at times the young girls are made to feel that they are not fully a woman until they have been circumcised. They are made to feel somehow dirty.
While Agnes was recovering at Ephuenyim Health Center, Nancy from NIWA, our partner in the water project, recorded a short interview with her. Agnes agreed to be interviewed and understood that talking about her brush with death due to the cutting, could help to dissuade other young girls from having circumcision. Later on a journalist from Unity FM, Radio Nigeria, contacted us and did a short interview with Dr. Fatoba. The interviews with Agnes and Dr. Fatoba were broadcast on national network.
January 9, 2012
Oniyenyi – Okpanko
We received an emergency call from Ephuenyim health center at 9 in the morning. They had a woman with serious seizures in the delivery room. We immediately bought magnesium sulfate and drove as fast as we could. It still took more than one hour to reach the health center. As we arrived the woman was still in convulsions and crying out in terrible noises. After getting the injections and other treatment from the doctor, it still took almost 45 minutes before she became conscious and calm. She had been in fits for several hours. It was classic case of pre-eclampsia, a condition that makes women very vulnerable to seizures and stroke in connection with delivery. It can diagnosed by protein in the urine, high blood pressure, headaches, oedema, etc. Young teenage mothers and also women past the mid forties are higher risk for pre-eclampsia.
She was only eighteen and her name was Onyenyi. She had been sent to stay with relatives of the father, some hours away. When they discovered that she was pregnant she was sent home. She could not or would not identify the father. In the morning of the 9th, Onienyi had gone out to gather firewood for cooking the morning meal. The soup was on the fire when she suddenly fell down at the kitchen door, convulsing. They carried her to Ephuenyim health center, about two kilometers away.
After the seizures had stopped, she was still in danger. Her blood pressure remained very high. She ran the risk having a life threatening stroke in connection with the delivery. The standard procedure with pre-eclampsia is to induce delivery. We carried her in our vehicle, along with her father and mother to Ebonyi State University Teaching Hospital. She was received at the emergency room. The doctors tried to induce delivery. When this brought no response, they decided to go for caesarean section. The CS went well, but the baby was not well.
The doctors worked with the baby for almost two hours, before he was stable. We visited them regularly for the next two weeks until they were released. We provided the medicines and items needed for the baby care, and also helped them with the bill for caesarean. When they were ready to go return to the village, we carried them home in our car. In appreciation the father gave us one fowl. We gave it to the staff at Ephuenyim Health Center.
April 12, 2012
Patience – Cross River
In the afternoon, in Offia Oji clinic, a woman arrived, supported between two men on a motorcycle. I did not see her well,her head was covered, and I thought first she must be an 80 year old woman, then I thought maybe an AIDS patient, as her arms and legs were so skinny. Soon I found out it was young woman of 30. Her name was Patience. Her head was shaved. A clear indication that she had been seeing the juju man or local herbalist. Her eyes and cheeks were sunken. She could not speak except moaning quietly, she could hardly sit, saliva was dripping from her mouth. The men, who turned out to be husband and brother, told that she was pregnant. We asked how many months, and she said nine months. But the stomach looked nothing like a pregnant woman, just sagging down.
Her condition was such that it was clearly beyond our health center to treat her. To make a long story short, after lots of back and forth, Maryjoy,who works with AMURT, with my support, convinced the family that Patience must be taken to the hospital in Abakaliki. She looked like she could die any moment. So we all went into our vehicle and took off for ABakaliki, a drive of close to 90 minutes. When we reached the hospital the first word of the doctor was that it looked like liver failure or kidney failure. We posted a deposit and the Teaching Hospital Emergency
Wednesday we went to see how she was doing, and were totally stunned to learn that at 3:20 in the night, Patience gave birth to a baby boy, and the baby is alive and well! We went to see her, and she smiled a very very faint smile, and complained in a low voice that she was not able to take a bath. The hospital staff explained how, being so wasted, she had no milk for the baby, so we must get baby formula for her.Room accepted her. Patience is from Cross River and don’t speak Igbo, and almost no words of English. We thought it must be water filling the abdominal cavity due to liver failure and that she is probably not pregnant.
We made all the arrangements and Maryjoy helped her to bath and fed the baby with the formula with help from the hospital staff. Then they told us that indications are that she has cancerous tumor in the mouth. They need to take more tests. This could explain her weight loss, the cancer and the difficulties in eating due to the tumor. In the evening we brought her clothes and baby clothes and the baby seems to be doing well. Her sister arrived from the village to help her with baby.
The happiness we felt seeing the baby alive…! We had been pessimistic and hardly considered that she was really pregnant, or if she was pregnant that it was indeed nine months and a woman in such a state could give birth to a happy baby.
Thursday we went to the hospital again and the news was not good. Patience was in intensive care after bleeding profusely from the nose. The doctors stopped the bleeding. They told us that she has cancer of the antrum (sp. ?), it’s a cavity near the nose and eyes, and that her case is terminal. She is now too weak to tolerate any treatment they have, and must just be restored and become stronger.
We told her that we can pay the bill and they should take care. But Patience did not want to stay. Earlier she had asked a few people if she was dead or alive. When they tried to put drip on her, she tore it out. She insisted to go back to the village, she seemed to have lost hope.. The husband, the hospital staff, all of us tried to persuade her for several hours, but finally the husband, and the hospital and us, reluctantly agreed to let her go. A driver arrived from her village with a vehicle and they went back.
Just as they left we asked the husband the name of the baby, and he said they had given the boy the name Miracle.
Back in Cross River, Patience was taken to a small health center. We visited her, and she appeared to be improving a bit. The condition of Miracle was not good. He was being taken care of by Patience’s mother and small girl of about thirteen. Turns out they were feeding him three times a day, while a newborn needs to be fed regularly round the clock. We provided the formula and gave instructions and they promised to do it correctly.
Over the next months we visited from time to time. Miracle improved and looked good. Patience returned from the health center. But she was not in good shape. She was in no state to breastfeed or apply herself to taking care of the baby. She would cry and complain and appeared to be out of touch with reality. In October we got the word that Patience had passed away. November was the last time we saw Miracle. He looked really good and they carried him on motorcycle all the way to Ephuenyim health center where we saw him. We continued to help from time to time with formula.
It was in March we heard that Miracle also had died. We felt guilty that we had failed. The village is actually far from our project area, and it’s difficult to go to. But we should have paid more attention. The circumstances leading to his death is not known. Their home village is the most depressing and one of the poorest villages I have seen in Africa or anywhere. A combination of poverty and ignorance and neglect.