A Night with "Nightingale"

Don’t get it twisted! The Nightingale I am referring to is not a girl, so sorry to burst your bubble. But look on the bright side, this is still a story of love … I’m sure you’re thinking what the heck is he on about? On the one hand, he says Nightingale is not a girl and then he says he’s talking about love. What does love have to do with this? You’re confused?  Let me tell you how I fell in love …

It was one cold evening and my daughter Nkechi couldn’t stop talking about this thing she had just discovered.  She kept going on and on about it. She told me it would assist and ultimately reduce the stress of taking care of me, especially during the night so it really pricked my curiosity. You see, some years ago a terrible accident left me almost paralyzed and, unfortunately, since then I've had to depend on my daughter for toilet care because my wife is late. For such a long time I was bedridden and had to deal with bed sores, it was truly an awful time for all of us. Well, back to the story, Nkechi had got to know about this Nightingale brand online and the solution it proffered for incontinent and bed ridden patients like me. So, she brought a pack home one evening because she was staying out.

After securing the Nightingale underlay pad on the bed I lay on it and immediately felt the smoothness of the surface on my bare back. It was really comfortable because I couldn’t remember falling asleep, but just after midnight the urge came knocking down my urethra door. My bladder was a full house and I really had to go, but there was no Nkechi to assist me in getting to the bathroom. I lay there groaning about what the bed was going to look like and how wet it would be all night long.  Ordinarily, when Nkechi doesn’t sleep over I sleep on the mat but not tonight. I had tried to get into my wheelchair, but just couldn't do it by myself so I was left with no choice … I can’t really remember how many times I leaked on the underlay that night. It had already crossed my mind that I would have to do some serious apologizing.

And yet here is the upshot of it all … the following morning Nkechi arrived early as promised and promptly starting getting me ready for my bath while she made the bed. Whilst she’s doing this I’m nervously wondering how badly I soiled it. It didn’t enter my head that the Nightingale underlay pad could hold all those ‘tsunamis.’ As my thoughts ran I heard, “Dad…” Quickly, I started to apologise but what she said next utterly threw me, “Wet? I was going to ask if you held your urine throughout the night, because the bed is completely dry. You know what the doctor said about, holding your urine”. Like magic the underlay had absorbed all the leaks. I was so relieved and so happy you wouldn’t believe. From that day on this underlay became a constant companion … I guess you could say I fell in love with it! Even my sleep improved because it removed all my anxiety.

I have recovered now, but each time I narrate this story to my family, we all burst out laughing. I later learnt that Nightingale underlay pads are used everywhere by midwives and consultants in hospitals during child delivery. They absorb all the fluids that come out with the baby.  Interestingly, also by patients with burn wounds and the likes because it assists in preventing lingering opportunistic bacteria and infections.  And not forgetting, by mums with young babies and toddlers in their beds, they help soak up any diaper leaks and night time accidents.  Even my 5 year old grandson is still using it as a mattress protector for those, “Just in case” nights! … It really has a multitude of uses.

For me personally, Nightingale underlay pads saved me from in-house embarrassment and allowed me to regain some lost dignity. It really helped me during a difficult time.  With its absorbent, soft material you can never go wrong using it. Did I mention it is very indigenous? Yes, it is made here in Nigeria … even better!!!

 

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Incontinence Pads

About an estimated 12 million people worldwide have been reported to suffer from some level of incontinence every year. Incontinence pads or adult diapers are the most common and arguably preferable solution to bowel and bladder control. They are extremely absorbent and decidedly wearable underwear (briefs) for incontinent and bed-ridden patients. The adult diaper acts as a protective undergarment which offers consistent leakage protection. General features of an incontinent pad include its cloth-like or plastic outer surface which is super absorbent as well as its unisex padding. In present day Nigeria, and arguably West Africa, incontinence products by Dr. Browns, Incoped and Suave outshine other competitions in this category (Euro-monitor).

Aside from bed ridden patients, an extrapolated figure of 848,362 people suffers from some sort of incontinence in Nigeria alone (WHO). Experts assert that 1 out of every 50 adults suffer from incontinence. Contrary to widely-held belief, incontinence pads or adult diapers are not only used by incontinence patients but also bed-ridden patients and individuals with cognitive impairment.

These pads are not only economically suitable but are an immediate alternative to surgery and other measures of incontinence management as they are worn  as under wears to prevent leakage and can really improve the quality of life as they save incontinence patients from being housebound or from spending a lifetime in the toilet. Other useful incontinence product for more serious leakages include urinals (urine collecting device), sheaths, and underlay towel pads which can be used in delivery rooms as well.

The major advantage of adult diapers or incontinence pad is their hygienic nature especially the disposable ones. Whatever incontinence product a patient may use, it is advisable to follow a realistic change in life style based on their urinary habits and healthy living as experts strongly suggests that incontinence is most times a symptom of a health issue and can be corrected in suitable conditions. Incontinence pads are undoubtedly a safe option for incontinence patients who wish to live a seamless life regardless.

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Incontinence

Incontinence is a term used to describe any accidental or involuntary loss of urine from the bladder, or in some cases, bowel motion. It is a partial or complete loss of control such that the organs will be unable to restrain the natural evacuation of urine and faeces. Incontinence is a common, but unfortunately one of the most under reported, global health issues with a reported prevalence of 27% and 43% (African Journal Online, 2010). According to National Institute of Diabetes and Digestive Kidney Diseases “urinary incontinence is loss of bladder control and symptoms can range from mild leaking to uncontrollable wetting” while “faecal incontinence is used to describe the leaking of the bowel, it becomes uncontrollable over time; it is mostly as a result of nerve disorder, acute diarrhea, constipation etc”. It can happen to anyone, but it becomes more common with age. Also women experience urinary incontinence (UI) twice as often as men.

Recently, WHO postulated that Urinary incontinence has been identified as a major health issue in developing nations like Nigeria and even in developed nations. According to experts half the female population will experience urinary incontinence at some time in their lives and over 10% of men over 65 have urinary incontinence to some degree as it is an increasing public health issue in the ageing population (allaboutincontinence.com). A research carried out in the northern part of Nigeria by Uro-Gynaecology Unit, Department of Obstetrics Gynecology of the Ahmadu Bello University Teaching Hospital, Zaria postulated that 74.4% of expectant mothers leak no more than once a week, 90% of them in small volume. There are different related conditions of incontinence; the basic is the urinary incontinence (UI) which is mostly associated with diabetes, childbirth, menopause and even arthritis. It ranges from occasional leaks to the constant need to visit the toilet. Experts have identified (2) two major types of incontinence:

Stress Incontinence: This is the leaking of small amounts of urine during activities like coughing, sneezing, lifting etc. It occurs when pressure is exerted on the bladder as the pelvic muscle is weakened by childbirth or surgery. It is common among women.

Urge Incontinence: This occurs when the sudden intense urge to urinate is followed by an uncontrollable leakage of urine, as the urge comes too fast before sufferers can make it to the toilet. It is also caused when the bladder is overfilled but sufferers are unable to totally empty it on time as the body gives only a few seconds warning. It is common among elderly men and is a sign of neurological disorders or diabetes, kidney infection and so on.

Incontinence, whether urinary or faecal, is often regarded as a social taboo, which is very wrong as it doesn’t make it any easier for sufferers to deal with the problem. In fact, it is considered a normal consequence of childbirth or aging that sufferers cannot escape. These are all misconceptions; for a fact, the pelvic muscle and bladder walls become weaker, but the changes can be controlled and, in fact, treated.

So what’s the treatment? Treatment depends on the cause of the problem and the type of incontinence. The incontinence will be cured if it is as a result of a medical problem. Experts recommend kegel exercises and bladder training for women as they help to reduce stress urinary incontinence. Sufferers are also advised to use adult diapers or incontinence pads to help control the leaks. Medicine and surgery are other options.


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Infant and Maternal Mortality in Nigeria

Recently, I ended up in a popular spot in Lagos state where a group of people crowded around a sidewalk, all beaming with joy and chattering away at the wonder they crowded around; a pregnant woman who had just been delivered of a healthy baby boy by a passer-by obstetrician in an emergency labour by that side of the road. The new mother was said to have been on her way to a traditional herb maker when she went into early labour before the doctor, who was on his way to his clinic, came to the woman’s aid in an event that wowed an impressed crowd.

About 37% of Nigerian women go to churches, local midwives and all sorts of professionally unqualified personnel for delivery of their babies. This is a disturbing phenomenon as this set of expecting mothers are exposed to higher risks of loss of their baby’s, as well as their own lives arising from complications that might unexpectedly become a problem before, during and after labour, as this may have fatal complications if not appropriately dealt with.

According to the United Nations Children’s Fund (UNICEF) record, “every single day, Nigeria loses about 2,300 babies under five years old and 145 women of child-bearing age”. This makes the country one of the largest contributors to the infant and maternal mortality rate of the world. Infant and maternal mortality is the death of a child or mother caused by diseases and other conditions related to pregnancy, labour, childbirth, etc. In Nigeria, 1 in 13 of pregnant women runs the risk of dying from pregnancy and child birth, with a significant portion of these deaths preventable. Traditionally, the most common causes of maternal mortality worldwide are, labour complications, diarrhea, pneumonia, hypertension, dehydration; while infants may die due to malnutrition, malaria, congenital malformation, infection and SIDS (Sudden Infant Death Syndrome).

Nigeria and many other third world countries have been touted as not so good places to give birth, or, in fact, raise a child, essentially because of the harsh economic predicaments and the abysmally low standard of hygienic practices. Experts at World Development Indicators (WDI) have asserted that both issues are a threat to fundamental human rights. Analysis of recent years proves that even though Nigeria has been cutting down the trend of infant and maternal mortality rates, it is still not close to the United Nation’s Millennium Development Goals (MDGs) of reducing the horrible plight by a third by the end of 2015. Underneath all these assertions and statistics lies the psychological trauma of thousands of families who have lost children, wives and mothers to this preventable scourge.

So why is the ratio of maternal and infant mortality still relatively high in Nigeria? The overarching problem has to be the stagnant healthcare system in the country that has been beclouded by inadequate equipment and facilities. Chief Nursing Officer in Ilasa Public Health Centre (PHC) had this to say “(members of) staff contribute money from their own pockets to pay PHCN officials whenever they come around for disconnection (of power supply); we still use lanterns and torch lights in the labour rooms”. In 2013, only 30 Public Health Centers (PHC) were assessable in Lagos; while out of the 30 PHCs, almost all were unable to handle post-partum-hemorrhage which is one of the leading causes of maternal mortality (ThisDay, April 2014).

Another cause of this pitiful plight can be traced to the incessant strikes of the Nigerian Medical Association (NMA) and the absence of palliative care in emergency situations, but this can also be traced back to the government’s commitment to an adequate healthcare system. Other equally dangerous causes may include sociocultural factors majorly illiteracy and poverty which have contributed to continued harmful traditional practices.

Experts have attributed the level of a country’s development to its maternal and infant mortality rate (Articles Ng, 2013). Thus, the lower the rate it happens, the higher the perceived growth of the country. Hence, this objective - to lower the mortality rate - is a national priority. Children and mothers are dying because those who are meant to prevent it are not acting or committed enough to cause massive improvement; the government and health professionals are not encouraging pregnant women to attend ante-natal clinics early enough especially rural dwellers. Rural areas should be a particular area of interest as they are areas that need a lot of orientation on harmful traditional health practices. Midwives should also get consistently updated education on safe delivery.

The complete disregard and sad disrespect of human lives should no longer be tolerated; a woman has no right to die while giving life and an infant should not be deprived of life due to our lackluster attitude to their welfare. We have to back our commitment to reducing this awful plight faced by mothers and infants with necessary actions.

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The Vesico Vaginal Fistula (VVF) Plague In Nigeria.

United States Agency for International Development (USAID) in partnership with Federal Ministry of Health and Ministry of Women Affairs has estimated that about 160,000 to 200,000 women develop Vesicovaginal Fistula (VVF) every year. Vesicovaginal Fistula and Recto vaginal Fistula (RVF) are holes resulting from the breakdown in the tissue between the vaginal wall and the bladder or rectum caused by unrelieved obstruction during labour causing continuous involuntary discharge of urine (urinary incontinence). The consequences related to these conditions may also include dermatitis, erosion of the skin and other tissues in the vulva and vagina with constant leaking of urine and faeces. Also, in extreme cases, nerves at the lower limbs can be damaged which may lead to loss of coordination. 

Historically, cases of VVF date back to the earliest existence of humans. It was an especially rampant problem between the 17^th and 19^th centuries in much of what is now the developed world. In fact, in 1855, the world’s first VVF specialist hospital was established in New York, United States of America. Everywhere in the world, VVF is seen as a social and economic scourge, as many women with the condition are regarded as social outcasts, deprived of their fundamental rights and privileges as they are left on the streets, or in deserted places far away from family and associates.

In most cases of VVF, there is a lethal obstruction during child delivery that causes prolonged childbirth as the unborn child is pressed tightly against the pelvis, cutting off blood flow to the vesicovaginal wall, which kills the tissue and makes a hole. According to experts, 90% of VVF is caused by unattended labor, and is especially common in women delivering for the first time.

VVF is responsible for over 55%-60% of divorce cases in Nigeria alone, as the VVF patient is enveloped by offensive odours resulting from the smelly nature of the condition. Teenagers are highly susceptible to VVF due to their small pelvic sizes. This is why it is unsurprising that it is very common in the northern parts of the country where early marriage is a norm which naturally results in early conception by the young bride. A VVF expert in the region has investigated how so many young girls lose their lives during childbirth, and how the ones that survive the ordeal are left almost incapable of conceiving ever again. Nigeria has been said to account for 40% of VVF cases in the world. This makes it a very big health concern for the country.

Experts have argued that the major cause of VVF is illiteracy as it is prominent in rural areas filled with uneducated women who have little or no access to information and adequate health care services. Recent research has established that most women prefer to give birth in traditional maternity centers than in proper health institutions. This is one of the biggest reasons for the high rate of VVF in Nigeria as ill-equipped and unskilled medical personnel are more likely to tear through their wombs, press hard on their abdomens and make so many other unhealthy choices. National Demographic Health Survey in 2012 estimated that every year in Nigeria, 12,000 more women will develop vesicovaginal fistula and only 5,000 will seek medical intervention and probably undergo surgery. Experts believe that by year 2015, these figures will double to at least 2 cases of VVF per 1000 pregnancies. 

Despite the fact that VVF is most prominent in childbearing, it has also been discovered to result from cases of violent rape and female genital mutilation. Conscious efforts have been made by the government and non-governmental organizations to combat this scourge with quite a number of VVF centers established in the northern parts of the country where it is most prevalent. However, it is still worth mentioning that these efforts have to be stepped up as these centers still remain underfunded. To improve maternal health, awareness should be created as to the importance of antenatal care for pregnant women to easily detect early cases of VVF when it can be easily cured; a service they won’t get from traditional maternity centers. Educational materials should be produced to create this awareness and primary health networks provided to the rural areas where poor uneducated women can easily have access to. VVF treatment is achieved by surgery and rehabilitation. This intervention package should also focus on repairing the mental, social and economical damage women suffer from VVF. These will be very vital to reducing the rate at which Nigerian women continue to suffer from a scourge that can be controlled and easily prevented.

                                                                                    Copyright © 2014 Wemy Industries.