The Renal Failure Epidemic

12 Mar 2013

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Transplant Survivor, Gbenga Ajibola

…Coming Soon to a Lawyer Near You?

World Kidney Day is a day set aside by the International Society of Nephrology, the International Society of Urology, ISU, and the International Federation of Kidney Foundation to raise awareness of the importance of the kidney to human health and its associated health problems worldwide.

According to World Health Organisation (WHO) statistics the death rate from renal failure was a staggering 3,400,000 in 2012 - ranking twelfth on the list of major causes of death in sub-Saharan Africa. In Nigeria, hypertension and diabetes mellitus are listed as the leading causes of end-stage renal disease. WHO estimates that by 2020 diabetes and cardiovascular disease would have increased by 130% in Africa alone.

World Kidney Day 2013 is set for March 14. A growing number of Nigerians, including lawyers, are dying as a result of kidney related ailments. Only last week, former chairman of the Nigerian Bar Association, Lagos Branch, Mr. Akin Akinote, was buried after succumbing to kidney disease at 57.

Kidney disease is very expensive to treat, the thought of it is painful to bear and the prospect of living long is relatively short. Few survivors have the means of managing the disease or even the chance to recount their stories.

Gbenga Ajibola, a 52-year old Insolvency Lawyer with over 30 years experience as a lawyer, is the picture of a true survivor. Diagnosed with hypertension at the age of 17, Ajibola never envisaged the renal failure that almost took his life and nearly broke his spirit.
Jude Igbanoi, Yinka Olatunbosun and Kunle Ogunfuyi were at his Ogudu home in Lagos last Thursday and had an insightful session with him…

Some Creeping Signs…
Gbenga Ajibola had been taking hypertensive drugs since the age of 17 as prescribed by doctors. Still, he had fun as an undergraduate student from a wealthy background.

‘By the grace of God I had well to do siblings, aunties and uncles. Before I graduated from University of Ife in 1983, I had been to 39 states in America. Vacation was part of my education. My mother believed in it.

‘The bottom line is that no sickness starts in a day. It creeps in on you, but we all ignore the vital signs. I had been warned by Dr. Ebun Bamgboye of St. Nicholas Hospital in Lagos who is arguably the most articulate nephrologist in the country with the best centre in Nigeria. He warned me in 1991, “Look you are heading towards the end-stage”.

‘For most people, these things don’t happen overnight. It is our lifestyles and predisposition that cause it. Medically, the major cause of kidney failure is diabetes. This is followed by long standing and or untreated hypertension.

‘However in West Africa another position has emerged. Herbs and concoction are leading causes beating hypertension to the second place. A lot of our people take all these bitters and concoction even in the office environment. These things kill the kidney.

‘When I went for my surgery in June, that was when I learnt that skin toning creams and skin lightening creams also cause it but the major causes remain diabetes and hypertension. If you have hypertension for a long time, you will develop diabetes. If you have diabetes for a long time, you can have hypertension. The two go hand in hand. Both of them are killers of men between 45 and 60. In the US alone, hypertension causes 50% of the cases reported. It causes stroke and all these other ailments.

‘All these things do not happen overnight. Some people do not even know that it happens! The renal failure is actually the end point of all these. My vendor’s junior brother suffered hypertension that later resulted into kidney failure. It was that kidney failure that led them to recognise that his ailment had metamorphosed into diabetes’.

Mortal Medicine…
Anyone who speaks with Ajibola needs to remind himself consciously that he is with a lawyer and not a doctor. Ajibola has done a lot of research on his health and other kidney related ailments. He now speaks the medical language. His findings reveal that the medical care system available in Nigeria is overdue for overhauling.

‘I have been taking hypertensive drugs since I was 17. I had a motorcycle accident in 1977 while I was in Ife. It was while I was being treated that it was discovered that I had hypertension, one without a cause. It was not supposed to be there because of my age.

‘Many of the drugs we are using in Nigeria are obsolete. For example I lost my former wife in 2002. The day she collapsed in the house we took her to a hospital where they had to do the Electrocardiogram (ECG). She had a clot in the lungs. The result did not even come out until after she had died. In her case, we did a test on Friday and we did not get the result until Monday. She collapsed again on Saturday and died on Sunday.

‘Sometime around July that same year, I went to the US and I collapsed but fortunately for me, my cousin’s husband is a doctor. He is the president of the Association of Nigerian Physicians and Medical Consultants in North America. When I got up from the bed to meet my children who were watching television in the living room, he noticed my disposition and called an ambulance. I was having air hunger that is, yawning which I found out to be a sign that the sugar level is high.

‘I just told a cousin of mine now who is lawyer that, ‘Tomorrow I’m taking you to the hospital. You are displaying signs of diabetes’. I am an extrovert and I will not keep my mouth shut!

‘I was diagnosed with diabetes in 2003. But by 2010, the diabetes knocked my kidney. Why? It was because of the drugs I was given in Nigeria. All I was told was keep an eye on your kidney but nobody tested the kidney.

‘Like every ailment, early detection will help. To measure how bad or good the kidney is, there is something called Glomerular Filtration Rate (GFR). I came back from India on February 20. There is a test for sugar level that does not tell a lie.

‘I was taking my medication but the problem was that I was taking bad medication as prescribed by doctors in Nigeria. I was taking the drugs and that is what caused the problem because it would expel the salt through urine by going into your pancreas and separating the salt from the urine. But it would keep the sugar. It would relieve the blood pressure and you will urinate well. Most hypertensive drugs will allow you to urinate but you only urinate salt and keep the sugar. It masks the kidney and eventually the kidney fails.

‘There is another form of insulin that could be given to me. Our doctors though very good, are not exposed to the modern techniques.’

Discriminatory Diet…
The normal dietary pattern changes for persons who live with long term diseases. Many are restricted from eating certain kinds of food and drinking anything other than water. For some the quantity of daily water intake is even regulated. Once in a while, a patient craves for the meals that he once cherished. When that happens, concerned family members often raise the alarm.

‘Yesterday, I wanted to eat dodo (fried plantain) but my wife said she would report me to my family members. She told my aunt, my cousin and my children. My daughter has called me this morning from Canada, “Daddy, I saw a message on Skype that you wanted to eat dodo. I don’t want to be fatherless. Let me find a husband and let me do my wedding first!” We joked about it.

‘There was a friend I asked what his GFR was. I asked him all the parameters. He did not know. This is not about money as in the case of my friend. All these tests cost less than N20,000 in Lagos. All the General Hospitals have these units for conducting tests. Fashola has subsidised the money. But most people don’t care and do not want to know.

‘I have a very close friend who is a lawyer and who does not want to go for tests just so that he would not hear any bad news. People should go for checkups every three months. I was doing mine regularly.’

Nigerian Medical Experts Abroad…
It is not uncommon that Nigerians who travel abroad for reliable medical care are often treated by Nigerian doctors who have become recognised in their area of practice. Many of these doctors never return to Nigeria. Ajibola explained that the system in Nigeria does not encourage the experts to stay.

‘My cousin-in-law, a director with Transcorp, is a member of ANPA (Association of Nigerian Physicians in the Americas). Their organisation went to Onitsha to offer free medical services and the doctors there organised armed robbers and they were chased away! They were rendering free medical services and the local doctors there said, “They want to spoil our market”.

‘I met a nephrologist, Omon’oba who is from Benin. He is leader of a team of medical experts and he is still in California. There are many of them like that and they will not come back to Nigeria. Nigerian experts don’t come back. My friend who diagnosed me with kidney failure hails from Auchi. He is a first class graduate and he is one of the best nephrologists in America. He was at my 50th birthday years back. He attends a Church that is well attended by Nigerians in the US.

‘He just walked up to me and said, ’You are not looking well’. After a test, he found out that my GFR was going low. He told me, “Gbenga, if you are not careful, you will do a transplant next year”. I started going back and forth. Money was not an issue. My clients from various banks and corporate organisations supported me financially. I started going to the US for routine checkups.’

Costly Care…
Little did he know that the flow of cash would ebb. As the condition grew worse, he spent more.
‘In America I was told, “This thing cannot be stopped, it can only be arrested”. On December 30, 2011, I got to find out that I had hidden syndrome. Signs do not manifest. The implication was that I would not die but the whole system would start collapsing.

‘Mind you, I was able to afford going to America every now and then. In 2011 only, I went to the US about 8 times flying Business Class. By the time I returned on April 2, 2012, I looked at the options. England was going to cost me 350,000 pounds and America was also expensive. Both countries were ruled out.

‘I became very emotional. If I was talking I was crying because I did not know whether I would survive. But I made up my mind that I was going to do it. Meanwhile, I prepared my family members for the worst. I told my children, “You guys, brace up, I may die”. My daughter said “Ha, God forbid I reject it!”

‘Fasting and prayers began. I thought I had money. Earlier I had got a N13m jeep, celebrated a birthday, had an on-going hostel project in Ife. But by the time I checked my personal accounts, I realised that I had spent a huge amount on travel and medications in the course of getting second opinion on my health condition.’

Funeral Forecast…
There is nothing as scary as a doctor predicting one’s death. Ajibola’s doctor and friend, having studied his medical history, told him pointedly that he was going to die last year.

‘When my friend came to Nigeria, he visited me on Easter Monday last year and warned me, “Gbenguse, if you don’t do this kidney transplant by the end of September, I will be at your funeral before Christmas.”

‘He was very emphatic. That was when I realised that it was a grave situation. I sold shares, and some of my properties. I thought that would be enough. But when the chips were down, I had to call on friends at some banks and my clients. Thankfully, they rose to the occasion. Some shares did not move and some lands could not be sold. I asked myself, “What do I do?”

‘The friends I called upon responded and the following day after speaking to one of them I just saw an alert - N1m! Two days later, friends from social clubs called to say they had some money to give me. They mobilised and tasked themselves on raising the money. They were calling themselves one by one to donate voluntarily. It was what Yorubas call, ‘Apa alapa, ese elese’ (meaning, help sought from multiple sources).’

Some senior lawyers who heard about his predicament did not wait for him to ask for their financial assistance. They all sent their voluntary donations to him.

‘I had a lot people come to my aid both private and corporate sponsors. A company where I resigned over 20 years ago sent me some money.

‘My elder brother; I had to threaten his life from India. I told him, “If I die I will come and haunt you”He had to go and borrow money to send to me.

‘A friend, in wisdom came to house and instead of giving me money gave $20,000 to my wife and said it was for emergency, “There could be an emergency and a need to urgently move you”. We paid that money to Emirate Airlines; so I have money in Emirates. If something happens to me this night, tomorrow morning I will be on Emirates flight. But how many Nigerians can afford all these?

‘A friend of mine said we should go to Oyo for some special prayers. We prayed. We paid for the donor, and the donor’s wife for the travel expenses and took care of the family. All this cost us about N30m. Meanwhile, I did not have all the symptoms that could show the seriousness of my condition- no swollen feet, face, I was just normal. I refused to go to parties anymore. I had told God that until he healed me, it is bye-bye to party life!

‘Friends started complaining that I had shunned their invitations for birthdays and other ceremonies. My Dean at Ife, Professor David Ijalaye named me, ‘Gbengus Pleasure’. I loved enjoyment. I always had accessories like hand chain, neck chain and rings. I was nicknamed ‘occasional student’ then at Ife because I repeated twice as an undergraduate. I was driving a big Toyota Camry. When other students were writing semester exams, I was off to London. By the time they finished, I would ask, “When are you resuming?” and then I would be back.’

Other Causal Factors…
Ajibola maintained that the unchecked lifestyles of many patients suffering from kidney diseases result in renal failure.
‘The average man lives in the suburbs and drives to the metropolis for about one hour. For a smoker, he would have taken five cigarettes. The first thing he does when he gets to the office is to get a cup of coffee, buy meat pie or biscuits. That is fat and cholesterol added to the stress. When he wants to relax, he calls a girlfriend, “How do we see later?” When he gets to the club, he gets a bottle of beer.

‘One of our greatest problems is the government. Our Coca-cola is one of the sweetest in the world. I’m told by the doctors in India that when you drink a bottle of beer, it translates to 20 cubes of sugar in your body. Most men, about 75percent before the age of 40 have truncal obesity, pot belly.  If your body produces good insulin, the fat will not allow the receptor cells to function properly. Most men do not know that they are hypertensive. When was the last time you measured your blood pressure? I warn you; these things don’t happen overnight!’

‘Mine basically was about my lifestyle. You know how it is. I am okay, I am a lawyer and I enjoy myself and doing everything with little regard for my health. Now let me tell you, we eat wrongly and our lifestyles are horrible. I just told you the way an average affluent Nigerian lives. He goes to the club, drinks different kinds of alcohol, he takes a girl somewhere and when you continue that way, problems are already on the way.

‘I have a friend a senior manager in a company and he had a problem. He had corporate sponsors and went to do his own surgery. He just came back. But how many people have such opportunities?!

‘A very close friend of mine was playing Lawn Tennis in Ikoyi Club when a woman in the MTN medical team tested him and they asked him to sit down. After about 20 minutes, they tested him again and they told him, ’Go and lie down there.’

‘Within 30 minutes, they collected his phone and called how wife and told her, ’Madam, your husband is very sick and he is not coming home tonight. Please come over to Ikoyi Club.’

‘The wife came from her office on the Island and the man was hospitalised for six months.  If that didn’t happen, he would have just slumped and died one day. You know Ikoyi Club is an elitist club. What if it were in some other place? He is in his late 40s.’

Government’s Intervention...
The World Health Organisation (WHO) constitution enshrines the highest attainable standard of health as a fundamental right of every human being. This right to health includes access to timely, acceptable and affordable healthcare of appropriate quality. This right is not the same as the right to stay healthy. Statistics show that about 150 million people across the world suffer financial mishap every year and about 100 million fall below the poverty line as a result of health care expenditure.

Government thus has the responsibility to generate conditions in which everyone can access health care facility.
It is sad that some organisations fail to provide health care schemes for their employees and deaths due to lack of funds to pay for medical bills have been recorded.

Ajibola’s view is that professional bodies such as NBA can look into the welfare of its members and not rely on government to stay healthy.
‘Government’s intervention is going to be minimal. We can generate resources and sensitise ourselves.

‘I know a health care management consultant; he is a Medical Doctor. He runs workshops for corporate bodies - MTN, Etisalat and many other companies. Sometimes they take staff of these companies on a weekend to these serene places for retreats and within the three days they will spend there, the health problems of these staff will be highlighted.

‘Each of us has a problem and we need the NBA to come in. We get experts to come and talk to lawyers. It can be done in batches, because it will involve a large number. They can go on retreats where you get people to jog and do other exercises. In the process, the problems will come out.

‘I can assure you that there are corporate bodies that will sponsor it. All these boys will donate huge sums of money for such programmes and you know, it is tax-deductable.

‘The NBA Section on Business Law did these health talks before during the tenure of Mr. George Etomi and many lawyers and judges benefited. His twin brother who is a nephrologist organised a number of these health talks in collaboration with other Nigerian medical doctors in the Diaspora.

‘Yes, in fact, Mr. Gbenga Oyebode the current Chairman of SBL is my friend.  We can do it again and I can help organise it. A good number of these Nigerian medical doctors abroad are my friends. We can organise it again.

‘All that we need to tell them is “Please come home and help. We need you guys”. It can be planned and they will be here at their own expense.

‘The money I expended in treating myself is more than a house in Lekki. But I thank God for my life.
‘The basic thing we are talking about is heart, liver and kidney, because these are what make up a human being.
‘I know these boys, they all have money and I can get them to come here and give these health talks. It can be arranged in such a way that they will do it during the vacation period and during Bar conferences. They will even do it for free. They will pay their own flight tickets, pay for their own hotels and even bring some of the drugs free. It’s all about planning.

‘I need to see the Bar President, Okey Wali SAN. Look at Akin Akinbote’s case now. I took his blood sample to India and when I came back I was at his house. Even two days before he died, I was with him. That is why I couldn’t bring myself to attend his burial. He was such a nice guy!’

‘All these young Nigerian doctors abroad are ready to help - my personal doctor who just bought 35 dialysis machines that he is bringing to Nigeria to help. They have the money.

‘I once met a guy on a flight, from a family of medical doctors. The senior brother owns the Bridge Clinic, their father is the late Dr. Ajayi. They all come in regularly to consult and operate. They are all in England, but they come in from time to time.

‘Do you know that 73% of Nigerian men have prostate problems and they don’t know? So all we need to do is to gather all these doctors, plan very well and come down here to do these things.

‘They have the money and the average American likes to give. They are philanthropic. It is here in Nigeria that we don’t like to give.
‘So many people are suffering in silence and they don’t know they are suffering. The drugs I came back from India with would cost an average of N180,000 monthly here. How many people can afford it? To do dialysis here in Nigeria costs an average of about N12 million yearly because a session is about N80,000 a day. That is dialysis alone!

‘Although there are other dialysis options, they are fraught with danger. India has a thriving medical tourism industry. Why can’t we replicate that in Nigeria? What is it they are doing that we can’t do? Our problem is that we don’t have a conducive environment for our medical experts to come back and work in.

‘The government and all of us are guilty. What about power supply? How do you guaranty that? In India we were made to pay $1,000 a month for three months on accommodation and it was a rip-off. We had to pay because we were desperate and that is what they do.

‘India in 2011 made over $246 million from medical tourism! In 2012 it went over $265 million and is rising. In India, each district has a dialysis machine.

‘Here in Nigeria , we hardly have such. The University of Ilorin Teaching Hospital just performed their first kidney transplant and they celebrated for months. In LUTH they did their first transplant and they celebrated for 10 days!’

Comparing the cost of kidney transplant in Nigeria to that of India, Ajibola said that although the procedure is cheaper here, it is fraught with a lot of dangers. He raised his T-shirt to reveal the scar from his surgery.

‘Look at me; these are 62 stitches from the operation in India. Nigerian doctors will cut between the penis and the groin and in the process destroy a lot of nerves in that area! My doctor friends in the US told me, “Never try dialysis in Nigeria. Come over here!”That is me. But what about the man on the streets?’

The First Lady of the United States of America , Mrs. Michelle Obama, recently launched a campaign   to advocate a reduction in the sugar content of Coca Cola which has been associated with a lot of medical conditions especially obesity in Americans.  Ajibola said there is also need for consumer rights to be protected in Nigeria.

‘My wife is a coca cola addict, even my little son will say, “Oh, mummy stop it!”
‘The ingredients used in manufacturing soft drinks in Nigeria are poisonous!  Nigerian Coca Cola is said to have the highest sugar content in the world!

‘Well, we have the Consumer Rights body that is doing something. There are lawyers there and they are doing something. As a lawyer I am going to do something about it now.’

Living With Kidney Failure…
No doubt, the magnitude of renal failure would take its toll on the sufferer. Ajibola paid more attention to his health at the expense of his source of income.

‘I have lost a lot! It affected my practice, my business and every area of my life. Before I came back from India a lawyer in my office collected a cheque for N650, 000 and disappeared. He has not been seen till today! I met one of my trucks stolen and another one was involved in an accident and completely damaged. I had lorries and many of them had their engines knocked before I can back. One of my drivers drove away with one of my cars and has not been seen till date.

‘When I came back I started with 72 drugs daily. Now, it is 42 daily. I take drugs almost every hour and I have to be exposed to at least nine hours of fresh air daily.

‘Then there was the spiritual side. Prayers! A couple was coming here to pray for me every day before I left for India. So many things happened. We must change our lifestyles to stay alive.’

Ajibola emphasised the need for constant medical checkups, positive lifestyle and adequate preparation for the rainy day which he said can come between 45 and 60 years for both men and women.

He brought out a travelling bag loaded with prescription drugs and told the THISDAY LAWYER team that he lives on those drugs and they would likely last for some weeks.
It takes courage and will to live that way.

Kidney Treatment (culled from Information Nigeria)

The typical renal patient has a 3 to 5 hour dialysis treatment, three times a week, and dialysis can only replace about 10% to 15% of the function of healthy kidneys. In Nigeria, each session of dialysis treatment will cost an average of N25,000, or N75,000 per week or N300,000 per month, or N3,600,000 per year, a cost much more than the average Nigerian worker can bear.

The incidence of kidney disease cuts across most ages and the prevalence is among patients aged between 20 and 50 years. This means that a significant number falls within the working population and may pose a serious threat to the future of Nigeria's economy. Something must be done now. All hands must be on deck to offer solutions to this problem.

Kidney failure or end stage renal disease is becoming a major issue in Nigeria due to increase in its incidence. Available statistics indicate that kidney failure is increasing worldwide by approximately 7% annually and the incidence in Nigeria could be as high as 10 per million population.

A kidney transplant, which costs at least N4.5 million, provides the patient with a healthy kidney from a donor but it often requires a lot more in terms of finances. When donors (which so far in Nigeria have been living relatives, spouses or friends) are found, their suitability for surgery is determined and they are tested to determine if their blood type and other issue factors match the patients. Some of these investigations are done abroad and this compounds the cost of the surgeries.

After the surgery transplant patients must take immunosuppressant drugs, which keep their bodies from fighting and destroying the transplanted organ, and these drugs must be taken for life with a combination of other drugs, which are usually not in stock by regular pharmacists due to their high cost. When required, they are often imported specially for the patients' use.

Across the World (culled from Nigerian News World)
In Sudan, the cost of treating kidney failure is subsidised, while in Europe and America, the cost is borne by health insurance companies for those with health insurance.

However, in Nigeria, due to less support from government, stakeholders used the World Kidney Day to raise consciousness on kidney donation, in addition to cautioning members of the public on the commonest causes of kidney failure which include diabetes, hypertension, HIV, hepatitis B and C as well as abuse of drugs such as analgesics.

Tags: Health and Wellbeing, Wellbeing, Featured, Failure, Epidemic

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