True Hero: A Tribute to Dr. Adadevoh

Medic-ALL (20:08:2014)

As we mourn the death of Dr. Ameyo Adadevoh, the Nigerian Consultant physician who passed on last night after having contracted the dreaded Ebola Virus from the Liberian-American Patrick Sawyer, it has been revealed that she indeed did a heroic job for the country when she forced the Nigerian Patient Zero, Sawyer, to his bed after he attempted to escape from the hospital .

Report says Dr. Adadevoh was infected when she forcefully restricted Mr. Patrick Sawyer to his bed after he tried to remove the intravenous giving set administered on him.

That one action, according to experts saved many Nigerian lives because, if Sawyer had succeeded in forcing himself out of the hospital, it would have been nearly impossible to trace those who had contact with him.

Dr. Adadevoh died at an isolation centre where she had been quarantined alongside other doctors and nurses who treated Sawyer at First Consultants Hospital, Obalende, Lagos.

Reports earlier in the week  had suggested that she had survived the disease and had been discharged from quarantine, until the Minister of Health, Professor Onyebuchi Chukwu issued a statement clarifying that she was not the survivor.

Her passing on brings the total number of deaths from the Ebola virus to five in Nigeria.

Our sincere condolences go out to her entire family. She is survived by her husband and kids.

Ref: DailyPost

Medic-ALL.Inc 2014

Doctors' Spouses: What's Not to Like?

By Parker Brown via Medpage Today:  

When it comes to domestic life for physicians, things have changed since an oversexed and gory 1971 film with Gene Hackman called "Doctors' Wives" featured as one of its taglines, "Doctors' wives have everything. Except husbands."

It turns out that there are, actually, documented cases of successful physician marriages. And some of those marriages are examined in a qualitative study in Academic Medicineby researchers from the University of Michigan Medical School.

They found four strategies for success for couples in which at least one partner was an academic physician:

• Have shared values
• Rely on mutual support
• Recognize the role of each family member
• Acknowledge that being a physician brings a benefit to the relationship

Those strategies weren't always easy to coax out of the 25 participants, though.

"The interviewer really had to work," said one of the authors of the study, Monica L. Lypson, MD, the assistant dean for medical education at the school and a practicing internist. "People ... love to complain."

But by doing an appreciative inquiry, focusing on the positive aspects only, the investigators found that there are indeed benefits to being in a relationship with a physician.

The Study

One of those significant advantages is money (which, if popular culture is any guide, can't buy happiness but can buy bacon, which is pretty close), the study found.

"My husband is a doctor," said Lypson. "So what we do is throw money at the problem. We don't have to get into who cleans the house."

Lypson said the idea for the study started when a medical student asked her how she went grocery shopping. Lypson, pregnant at the time, was a little insulted. "Well, I get in my car and drive to the store."

But the student was really asking how she managed her work, her patients, her relationships -- and how her relationship with her husband fit into all that.

Out of the interviewees, 12 were female and 13 were male. They had been married an average of 15.8 years.

Three of the participants were non-MD spouses of a physician, while the other 22 were physicians; of the latter, 10 were in a dual-MD relationship. And 40% of them got married while in residency, while another 40% were in medical school when they got married. Kids came later -- 52% of them had their first child during practice.

Included as limitations were the fact that all participants were involved with an academic medical center and the authors explored only the positive aspects of physician marriages.

Several of the participants noted the importance of support from extended family, said Lypson and her colleagues, Rachel Perlman, MD, and Paula T. Ross, PhD.

One interviewee said, "My dad saved my marriage a couple times, which was remarkable, because he was kind of a sh*tty father." During his internship year, his son and wife got sick and had diarrhea when he was on call. He called his father for help, so the dad flew in and took care of the family for 3 days.

Partners In Hardship

Helen Cappuccino -- one of several physicians MedPage Today interviewed for this story -- is an MD at Roswell Park Cancer Institute. She's had six children with her husband, a spine surgeon and team physician for the Buffalo Bills.

"When our fourth child was born, I was already pretty good at it," she said. When she was 8 1/2 months pregnant, it was her chief year as a general surgical resident and she was determined to do a surgical procedure she had been waiting to do despite a fourth-year resident eagerly waiting to step in.

But after a pre-operative medication issue, the surgery was delayed a week. "I always joke that I had my legs crossed that whole week," she said. But she made it, and after the surgery, "I walked from the OR upstairs to deliver our baby," she said.

"The biggest benefit is having somebody who understands what you've gone through and what you go through on a daily basis," said David Sandberg, MD, a pediatric neurosurgeon at the Children's Memorial Hermann Hospital, where he works with his wife, Amy Schefler, MD, a pediatric ocular oncologist. "It's very rewarding to have somebody go through that journey with you who understands it," Schefler said.

They were married while Sandberg was in residency -- the only honeymoon they had was when they got to hang out in the surgical room together.

Kim Boggess, MD, is a professor of maternal-fetal medicine at the University of North Carolina (UNC). Her husband is also an MD and a professor at UNC in the gynecology oncology program, and Boggess says that makes for sometimes interesting conversation.

"One particular dinner table conversation involved talking about a fairly graphic surgery involving the vagina and cervix," she said.

They were unaware that their two kids, ages 14 and 11, were sitting at the table "with their mouths gaping open in shock at our candor." That led to a family pact that the doctors wouldn't use the "V word" at the dinner table again.

In cases where there's only one physician in the relationship, one spouse can get free medical advice.

"I've completely convinced my husband of using alcohol-based wipes," said Michelle Barron, MD, a professor in the division of infectious diseases at University of Colorado Denver. On her first date with her now husband, they went out for ice cream. She watched nervously as the ice cream from the cone dripped down around his hands, and as soon as they got back to the car pulled out her alcohol wipes to clean him off.

"He's in management, always shaking hands," Barron said, before proudly adding, "But he hasn't been sick in years."

Mixing Home and Work

Things can sometimes get messy when family relationships become business ones as well.

Steven Peltz, a certified healthcare business consultant, said he was doing an operational review for a young male dermatologist. Peltz told him that the lady at the front desk was too tough on her colleagues, aggressive with patients, and had poor interpersonal skills.

"I know," said the doctor. He then asked Peltz to fire her, a task Peltz declined. When Peltz asked why he couldn't do it himself, the doctor said, "Because she's my mom."

On the other hand, one married couple -- ZoAnn Dreyer, MD, a pediatric oncologist at Texas Children's and Jeff Dreyer, MD, a pediatric cardiologist at the same hospital -- frequently shares patients; they say they enjoy working together. To avoid confusion, patients refer to ZoAnn Dreyer as "Ms. Dr. Dreyer" or "Mama Dreyer" and Jeff Dreyer as "Papa Dreyer."

But for Aruna Ganju, MD, a professor of neurological surgery at the Northwestern University of Feinberg School of Medicine who is married to a plastic surgeon, the one time she and her husband shared a patient ended in an argument. She prefers those two worlds stay separate for now.

Medic-ALL.Inc 2014

Ebola Contaimment: A Rare piece of Good News from Nigeria

BusinessDay (19:08:2014):

In the midst of the gloomy news that Nigeria is often associated with comes a ray of hope that the country can indeed get things right when its officials and people put their hearts to work.This is the story emerging from the handling of Ebola outbreak in West Africa, where Nigeria’s officials have been able to contain its spread in Africa’s most populous country with over 168 million people.

This response has received huge commendations from the United Nations Population Fund (UNFPA) and the international community.

Following fear and anxiety the lethality of the Ebola outbreak has generated since it came into the country through late Patrick Sawyer, a Liberian-American, on July 20, 2014, Nigeria is racing to halt Ebola Virus Disease (EVD) from spreading, including tracing individuals known to have had contact with confirmed cases, training health care professionals to identify EVD, and raising public awareness of symptoms.

This cheery news comes as contact tracing in Nigeria has resulted in a range of between 94 percent and 98 percent of contacts of EVD cases being identified and followed up, according to the World Health Organisation (WHO).

With Nigeria recording 12 confirmed EVD cases, this development comes as a relief and provides a window to wipe out the disease before it gets out of control, as it has in Guinea, Liberia and Sierra Leone, claiming 1,066 lives, with 1,963 EVD cases confirmed since the outbreak began in December 2013. Onyebuchi Chukwu, minister of health, had announced yesterday that four additional confirmed cases of EVD who had been managed successfully and were now disease-free had been discharged.

“The four persons include two male medical doctors and one female nurse. The three participated in the treatment of the index case, while the fourth person was a female patient at the time the index case was on admission,” a statement from the ministry said.

This brings to five the total number of patients diagnosed with EVD who have now been discharged from hospital.

On the Federal Government’s containment efforts, Chukwu told BusinessDay that state governments were urged to institute a communication strategy to ensure mass awareness creation and sensitisation for individuals and communities on EVD in a bid to halt the spread of the disease. Federal and state ministries of health and the human services secretariat of the FCT administration were also directed to provide adequate incentives to health workers participating in the management of EVD patients, he said.

Chukwu said Nigeria’s partnership with WHO, UNICEF, the United States Centre for Disease Control and Prevention (CDC), local authorities and international partners in the area of technical capacity, health facilities for isolation of EVD patients and other containment efforts was aimed at halting EVD spread.

“The Ministry of Health is procuring isolation tents to quicken the pace of providing isolation wards in all states of the federation and the Federal Capital Territory. We are also setting up a special team to provide counselling and psychosocial support to patients, identified contacts and their families,” Chukwu explained.

“189 persons are under surveillance in Lagos and six persons under surveillance in Enugu. All the persons under surveillance were secondary contacts. All the patients under treatment have now moved to the new 40-bed capacity isolating ward provided by the Lagos State government. Additional equipment has also been made available to the new isolating ward by the Federal Government,” he said.

Chika Mordi, CEO, National Competitiveness Council of Nigeria, said Nigeria has done creditably well in containing the spread of EVD in the country. While Nigeria is perceived in the international community not to have functional institutions, Mordi said the case management of EVD in Nigeria has proven that the nation has functional institutions.

He said “If you compare the way Nigeria have handled the case of EVD outbreak when compared to other Ebola affected countries within the West-African sub-region, you will agree that we have done an excellent job. We can also improved upon the success.

“You may remember that the outbreak started in Guinea and then spread to neighbouring Sierra Leone and Liberia. Remember that the index case who brought EVD into Nigeria was visibly ill when he stopped over in Togo and yet Togo said they dont have any case of EVD. Ivory Coast which borders Guinea say they dont have EVD cases.

Don’t forget that in the last few months, Nigeria has been on the front burner on CNN and other news channels in the area of insecurity, suggesting that we don’t have functional institutions. The way we have effectively managed EVD in Nigeria suggests that the country has functional systems in place which could be improved upon.”

Another impressed observer of Nigeria’s handling of the Ebola outbreak narrated his experience at the Murtala Muhammed International Airport, Lagos yesterday. He said, “I was at the airport this morning (yesterday) to see off a relation and as she went in to board, she and other passengers were screened by health officials who not only checked their temperature but asked questions like how they felt, where they had been and it was damn effective. A rare case of us doing the right thing. I was so impressed and it shows how far we can go if we do the right things.

Babatunde Fashola, Lagos State governor, said the government was not shying away from its primary purpose of protecting and saving lives, as the state House of Assembly had approved additional expenditure to fund efforts at containing the spread of the disease. “My view of the fact that we are gaining control is informed by verifiable facts that I receive daily from our health workers that all the cases of those who have either unfortunately died, or those who are sick, and those who are contacts under surveillance are directly traceable to the imported case. This is encouraging news from which our containment strategy can profit greatly; because it means that we do not have any case of unknown origin, which will raise the risk of an epidemic,” Fashola said.

Adebayo Onajole, director of communication and community mobilisation for Ebola in Nigeria, said the country had been able to contain the spread through increased surveillance at the country’s borders (air, land and sea), increased awareness and less of disinformation of the disease in the country.

Onajole, who is also a consultant public health physician, noted that universal health precautions and personal hygiene were currently being encouraged, a situation  that would halt the spread of the disease.

“Efforts are currently ongoing to scale up and strengthen all aspects of response, including contact tracking, public information and community mobilisation, case management and infection prevention and control, and coordination,” he said.

“There is now increased disease surveillance system in a bid to monitor, control, and prevent any occurrence of the disease,” he added.

Five committees have been put in place in the country to halt the spread of the disease, BusinessDay investigation reveals. These committees include contact tracing (responsible for tracing contacts of infected person), case management unit (responsible for managing established cases), and point of entry unit, which is charged with the responsibility of examining persons entering Nigeria from various borders.

Besides the Federal Government’s N1.9 billion Ebola Intervention Plan announced by President Goodluck Jonathan, Aliko Dangote, chairman, Dangote Group, announced the donation of over N150 million from Dangote Foundation for the establishment of a National Ebola Emergency Operations Centre (EOC) at Yaba, Lagos.

The EOC is a key part of Nigeria’s response to the outbreak of Ebola on its shores. Headed by Faisal Shuaib, a US-trained public health expert with extensive international experience, the centre serves as the engine room of national response, providing a coordinating mechanism for prevention, surveillance, patient care, tracking, data analysis and containment of the spread of the virus.

It also facilitates coordination of partners, serves as a platform to link to the medical community across the country and also internationally, especially with countries also battling the virus in West Africa.

Public health experts believe EVD can be stopped through maintaining high effective control mechanism and communication within communities on proper hygiene practice.

“We do know how to stop Ebola. Its old-fashioned plain and simple public health: find the patients, make sure they get treated, find their contacts, track them, educate people and do infection control in hospitals,” said Thomas Frieden, director, United States Centre for Disease Control and Prevention.

By Alexander chiejina

Presidential Order and A Populace At Risk!

Medic-ALL (17:08:2014)

It is no longer news that the President of the Federal Republic of Nigeria in his "wisdom", last week Wednesday came up with the most bewildering and drastic of responses to the now over 6-week old nationwide doctors strike by the Nigerian Medical Association (NMA), by indefinitely suspending residency training in the country and the subsequent termination of the appointment of about 16,000 doctors presently enrolled in specialist training in the country.

While I was not particularly shocked to hear the news, I continue to be burdened by the consequences of such an action in the light of the sorry state of the health sector presently. It will be interesting to see what the Government has up it's sleeves in the coming days, weeks or even months, in terms of filling the huge vacuum left by the sacked resident doctors who make up about 60% of registered doctors presently practicing in the country. There is no doubt that the plan of employing locum doctors on a 6-month contract basis alone will not suffice for a populace that has being hugely under-served even in the prior era.

That's true , there's the Nigerian populace!!...A Population Base of 167,000,000 who should be perhaps as worried as I am. They should actually be asking how the Government intends to provide access to adequate specialist medical care if specialists will no longer be trained by hospitals they pay taxes to maintain. Nigerians should be wondering if the Government is going to bring in foreign expatriates (like was once done!) to fill up the hole it would have created in the  sector and at what cost adequate healthcare would now be available to the masses. Whether the Government will pay more to maintain the expatriates than it would have to meet some of the demands of the striking doctors and upgrade infrastructure in our fast-rotting away medical schools built in the 1960s and '70s would also be a valid question at this time.

I do think that it is extremely important that the Nigerian people understand the intricacies of this "remarkable" Presidential order especially in a country such as ours, where a striking majority of our elected leaders and their families seek medical attention for as little as a running nose outside the country. It becomes even more necessary for the populace to be aware of the possible ripple effect of such a decision as made by the Federal Government standing in the coming weeks to months and should subsequently begin asking the questions that really matter, as it stands logical that only the wearer of a tight pair of shoes knows for sure where it hurts.

While the Nigerian Medical Association have openly condemned the obnoxious sack and are ever resolute to challenge the order, I strongly believe, that the Nigerian populace have even more to fight for, not just in response to this preposterous directive but for the quality of healthcare they deserve in every single part of the country.

Medic-ALL.Inc 2014

Ebola Fight: Nigeria trains Volunteers amidst Doctors' suspension

Medic-ALL (16:08:2014): 

Nigeria has said it has trained 800 volunteers to battle Ebola as fears rose that the worst-ever outbreak of the deadly disease could spread across Africa's most populous nation.

Authorities in the capital Lagos last week appealed for volunteers to make up for a shortage of medical personnel because of a six-week nationwide doctors' strike over pay.

Volunteers have so far been deployed to 57 districts of Lagos state but more are needed, particularly to treat those already infected with the disease, Hakeem Bello, a spokesman for Lagos State Governor Babatunde Fashola.

"We have trained some 800 volunteers in the area of contact tracing, sensitisation and treatment of the Ebola disease." said Bello.

Four people have died and six more are infected by Ebola in Nigeria as part of the worst-ever outbreak of the deadly virus, which has killed 1,145 people across west Africa this year.

Experts say Ebola is spreading out of control in the region, and the UN World Health Organization has declared the epidemic an international health emergency and appealed for global aid. The disease erupted in the forested zone straddling the borders of Guinea, Sierra Leone and Liberia earlier this year and spread to Nigeria last month. The districts of Kailahun and Kenema in eastern Sierra Leone have become the new epicentres of the outbreak, with charities and health authorities there scrambling to contain the spread of the disease.

US to provide extra aid

But officials fear an outbreak in the key regional hub of Nigeria could be far more dangerous, and US health authorities pledged this month to send extra personnel and resources to Africa's most populous country, as Nigerian doctors continue a strike across the country since July 1 to demand a pay rise and better working conditions. The Lagos' state government has stepped up a media campaign to raise awareness of how to prevent the spread of the disease, including radio and television advertisements and public health announcements.Nigeria has also withdrawn its athletes from the Youth Olympics in the Chinese city of Nanjing as a result of the outbreak, state media reported as the games opened on Saturday. The International Olympic Committee has barred athletes from Ebola-hit countries from competing in pool events and combat sports, affecting three athletes.

Canada and the United States are both sending consignments of largely untested drugs in the hope of saving hundreds of lives, but officials warn they are likely to have little impact.

Source: AlJazeera

Medic-ALL.Inc 2014a

Ebola Outbreak: Vastly Underestimated

WHO (15:08:2014)
Though more than 1,000 people have died in the world's worst ever outbreak, the UN now says that number may be higher.

Staff with the World Health Organisation battling an Ebola outbreak in West Africa see evidence the numbers of reported cases and deaths vastly underestimates the scale of the outbreak, the UN agency has said on its website.

The death toll from the world's worst outbreak of Ebola stood on Wednesday at 1,069 from 1,975 confirmed, probable and suspected cases, the agency said. The majority were in Guinea, Sierra Leone and Liberia, while four people have died in Nigeria.

The agency's apparent acknowledgement the situation is worse than previously thought could spur governments and aid organisations to take stronger measures against the virus.

"Staff at the outbreak sites see evidence that the numbers of reported cases and deaths vastly underestimate the magnitude of the outbreak," the organisation said.

"WHO is coordinating a massive scaling up of the international response, marshalling support from individual countries, disease control agencies, agencies within the United Nations system, and others."

International agencies are looking into emergency food drops and truck convoys to reach hungry people in Liberia and Sierra Leone cordoned off from the outside world to halt the spread of the virus, a top World Bank official said.

In the latest sign of action by West African governments, Guinea has declared a public health emergency and is sending health workers to all affected border points, an official said.

An estimated 377 people have died in Guinea since the outbreak began in March in remote parts of a border region near Sierra Leone and Liberia.

Guinea says its outbreak is under control with the numbers of new cases falling, but the measures are needed to prevent new infections from neighbouring countries.

"Trucks full of health materials and carrying health personnel are going to all the border points with Liberia and Sierra Leone," Aboubacar Sidiki Diakit president of Guinea's Ebola commission, said late on Wednesday.

As many as 3,000 people are waiting at 17 border points for a green light to enter the country, he said.

"Any people who are sick will be immediately isolated. People will be followed up on. We can't take the risk of letting everyone through without checks."

Experimental drugs

Sierra Leone has declared Ebola a national emergency as has Liberia, which is hoping that two of its doctors diagnosed with Ebola can start treatment with some of the limited supply of experimental drug ZMapp.

Canada's Tekmira Pharmaceuticals Corp is also exploring making more of its experimental Ebola treatment, Chief Executive Officer Mark Murray said.

Nigeria also has declared a national emergency, although it has so far escaped the levels of infection seen in the three other countries.

Ebola is one of the world's most deadly diseases and kills the majority of those infected. Its symptoms include internal and external bleeding, diarrhoea and vomiting.

The US State Department ordered family members at its embassy in Freetown to depart Sierra Leone because of limitations on regular medical care as a result of the outbreak.

Source: World Health Organization(WHO)                  AlJazeera

Medic-ALL.Inc 2014

Nigerian Government Supends Residency Training

(THEWILL)14:08:2014 – President Goodluck Jonathan Wednesday suspended the Residency Training Programme for medical doctors in Nigeria indefinitely and sacked Resident Doctors in all federal government owned institutions.

The President’s directive follows the protracted industrial dispute between doctors under the auspices of the Nigeria Medical Association (NMA) and the federal government over pay and poor funding for government owned health institutions.

An internal memo to all heads of federal tertiary health institutions signed by the permanent secretary in the Ministry of Health, L.N. Awute, on behalf of the Minister of Health, directed them to sack all Resident Doctors in their facilities with immediate effect and directed that measures be taken to restore full medical services in their hospitals.

A member of the board of the NMA has described the sack of resident doctors and the suspension of the Residency Programme as a knee jerk reaction to the dispute between the federal government and the NMA.

In a reaction to the development, the official who asked not to be identified in this report told THEWILL that an emergency session of delegates has been called by the NMA to deliberate on the development adding that a formal statement condemning the decision of the president will be issued momentarily.

The official said the President targeted the weakest link amongst doctors by going after thousands of the residents adding that with their sack those hospitals no long qualify as teaching or specialist hospitals because you cannot operate them without residents and consultants. “It is just like you cannot have a school when there are no students and teachers” the official said.

“We have been through this before at least twice. Government never learns. The action of the President is disappointing. Instead of addressing the serious issues we want dealt with the President is escalating the problem,” the official added.