Tuesday, 13 March 2012

POVERTY: Nigeria: the reality of medical practice!

I have been practicing in rural Ibarapa district since 1983. Although I am surgeon, we offer preventive services as well in form of immunization for adults and infants and regular health education talks.

In the past two decades, the day at the outpatient clinic starts with a health talk on water-borne diseases among other common diseases like malaria, hypertension, diabetes mellitus, HIV/AIDS and tuberculosis.1 Our usual health talk goes like this:
“Typhoid fever, cholera, infective hepatitis, gastroenteritis and guinea worm are the common diseases in this environment that are acquired through the drinking of unwholesome water. The water we drink from all sources, except rain water that is harvested, is easily contaminated by faeces deposited in open spaces (which is the usual practice) and washed into these sources by the falling rain.
“Even pipe-borne water is not safe because most pipes are rusty and have burst. So, when Water Corporation is not pumping water, the contaminated pool of water at the leakage points will flow back into the pipes and will be pumped into households when the corporation resumes activity. It is not economical to drink sachet or bottled water routinely. It is meant for social events.
“To make the water from these sources potable, we advise you warm the amount you would need the next day in the evening so that it is cool by the following morning. You need not heat to boiling as all germs that cause these diseases will die as soon as the water is warm to touch.
“Please practice this piece of advice and pass it on to your relations and neighbours as prevention is not only better but cheaper than cure.”
A medical student and I reviewed of mortality at ACE from 1987 to 2001 analyzed at five year intervals, we found that the incidences of typhoid fever, gastroenteritis, infective hepatitis and cholera as causes of mortality dropped by over 80 per cent.2 There has been no cholera outbreak in rural Ibarapa district for over 15 years now even with no improvement in the municipal water supply.
So, while Nigerians are waiting for potable pipe-borne water, warming drinking water before use is a pragmatic option to prevent water-borne diseases.

Awojobi O A Letter: Pragmatic option for preventing water-borne diseases in Nigeria. Afr Health 2011; 33: 12.

2. Awojobi O A and Olaleye O A Causes and trend of mortality in Ibarapa. Dokita 2003; 29: 53 - 56.

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