Mint Stethoscope – A Guide for New Doctors

Official ebook release poster

It is so exciting to see this book released finally.

I wish I had this guide before starting my house job journey but I remain grateful for all the guidance I gathered from different sources.

We at Health Hub Africa present our contribution to making the path easier for those coming behind us. We must end the cycle of undue suffering. The rigours of medical practice are enough to deal with. Young doctors do not have to face extraneous ones that do not help their overall growth, care delivery and wellbeing.

The radiant cover page

It has been shown that many who get disillusioned with medical practice feel that way due to the lack of support or proper guidance during their crucial first year. By sharing this free ebook, you are investing in the career of young doctors and by extension strengthening the Nigerian healthcare system.

List of contributors

Well done to everyone who made this a reality. It was an honour to be the contributing editor of this work.

Help share word by using this picture, the Twitter hashtag #HouseOfficersGuide and the download link bit.ly/mintstethoscope.

__________

Dr Mariam Toye

Editor

Living Free of Pain – World Sickle Cell Day

Excruciating pain, drinking a lot of water, frequent hospital admissions, breaks from school or work and dealing with many restrictions to a normal life forms the perception of sickle cell for most of us. While these are present in many cases, the truth is that with adequate care, people living with sickle cell do lead wholesome and fulfilled lives. World Sickle Cell Day was first marked on June 19th 2009 after being recognized in December 2008 by the United Nations General Assembly as a disease of public health concern.

Sickle cell is a chronic condition commonly found in people of African, Mediterranean , Middle East and Indian descent. It is a group of disorders in which the biconcave red blood cell structure (picture the Trebor sweets of your childhood) is distorted into a sickle shape (like the sickle used in farms , crescent or the curve of a question mark). The biconcave structure of normal cells make them flexible to navigate smaller vessels. The distortion affects the ability of these cells to carry oxygen to different parts of the body leading to them being deprived. The abnormal shape makes the cells rigid and unable to navigate small blood vessels in the circulatory system. This gives rise to the joint and other severe pains experienced by sickle cell patients.

Cause

The molecule , haemoglobin is the part of the red blood cell that carries oxygen. Sickle cell disease is caused by a genetic mutation which gives rise to Haemogblobin S or Haemoglobin C. The expression of the heamoglobin types make up the genotype of a person. Examples of geneotypes are AA, AS, AC, SC or SS. Sickle cell genotypes are SC and SS. AS and AC are carriers.

A child has sickle when she inherits the S or C gene from both parents.

Signs and Symptoms

These begin to show in early childhood and range from mild to severe among people affected. In most cases, the recurrent bouts of illness is often the first time the child’s genotype is identified. This can be especially traumatic for children who may not be able to express their feelings clearly. The younger ones among them are irritable – cry incessantly due to pain. Episodes of pain and other symptoms are also known as sickle cell crisis.

The sickled cells break down faster than normal red blood cells leading to anaemia. Anaemia in turn leads to breathlessness, weakness in addition to slowed growth and development in Nigeria.

Because the tissues of the body’s organs are starved of oxygen, they begin to show signs of damage. Among these complications are vision loss, bone degeneration, kidney damage, heart failure and poorly healing wounds on the legs (leg ulcers). If left untreated some of these complications can lead to death.

Diagnosis
Sickle cell can be suspected from the symptoms above but it is confirmed with genotype and other other clinical tests.

Treatment
Water – a cardinal part of managing this disease is for the patient to drink or be infused with adequate amounts of water. Sometimes, up to 3 litres per day. This aids circulation and helps reduce the joint pain.

Medication – Sickle cell patients take medication daily to prevent malaria, keep up their vitamin levels. This prolongs the life of the red blood cells and helps new ones to form. However, iron supplements does not help patients with sickle cell as the anaemia found in them is not due to a deficiency of iron. Antibiotics are given to clear existing infections. Hydroxyurea has been shown to improve symptoms significantly in sickle cell. This is usually prescribed by doctors experienced in the treatment of sickle cell. Since severe please (crisis) is often what brings most patients to the hospital analgesics are a major part of the treatment.

Blood transfusion is given to patients whose anaemia is severe to increase their blood levels. This is usually done in severe cases to save their lives.

Hip and other replacement surgery in case of fractures due to bone degeneration.

Recurrent cases are managed by haematologists who are medical experts in blood disorders. With adequate and timely treatment, many sickle cell patients lead fairly normal lives.

Cure
Sickle cell can be cured with stem cell or bone marrow transplant. This option remains inaccessible to most patients due to the high cost, the challenges of securing a matching donor and risk involved. However, many survivors have been cured with this procedure.

Prevention
People with AS, AC , SC and SS genotypes are advised to marry those with AA genotype. This prevents the incidence of their child having the disease. In many marriage registries and even religious bodies, a genotype test and counselling is increasingly becoming one of the criteria for the intending couples.

Growing Stronger With Sickle Cell
Adequate hydration as explained above reduces the frequency of crisis. Also, keeping warm in cold weather helps to prevent the joint pain and chest pain which is worsened by cold. Places or activities that lead to reduced oxygen levels should be avoided. These include high altitiudes and strenous activities. Improved hygiene helps to prevent infections and can be a lifesaving habit in this regard.

Counselling for patients and their carers is very important as the disease can take a toll on mental health. This helps them choose a healthy diet, regular water intake and practise all the the coping mechanisms above. Support groups have also been very helpful in helping patients stay strong.

For decades, we have had people with sickle cell attaining great heights in different fields of human endeavour. We must continue efforts to ensure that less children with sickle cell are born by ensuring genotype testing in couples. But for those who are living with the condition, practising these tips above helps them to lead normal lives.

Written by Dr Mariam Toye (@TheMariamToye on Twitter)

Social Media Ethics For Health Professionals – How working to solve a problem birthed a book

Social Media Guide For Health Workers

“In today’s world of putting out thoughts and opinions online in a flash, how does a health professional maintain a profile within the limits of ethics?

In recent times, there have been concerns about how some health workers post content on social media. This made it imperative for some of us at Health Hub Africa to come together and work out a way of salvaging the situation. The general theme on this forum is to avoid complaining about problems that pop up everyday or surround us. Rather, we work on providing a solution or even put forward proactive ones to other problems we think can be nipped in the bud by observing trends before they become a menace. These deliberations developed gradually until we had a book on our hands!

Dr Ayomide Owoyemi, Dr. Ronald Kelechi Ikpe, Foluke Olaniyi-George, Olusegun Abraham, Weyinmi Erikowa-Orighoye, Iyewande Dipeolu M.D. and I are happy to present this ebook to you.

It is an honour to finally be able to do so

You can now download (for free) the Social Media Guide for Health Workers ebook using these links

http://Bit.ly/smhguidefull
http://Bit.ly/smhguideabridged

It is our hope that it helps health professionals leverage on social media while staying within the limits of ethics. This will protect not only their patients but themselves and the general public.”

Dr Mariam Toye

A page from the book on good social media conducts

REVIEWS

“Knowing what not to do is equally as important as knowing what to do.” ~Steve Harvey

For medicine, it might be more important, if the first thing you must know is to do no harm. This guide contains well written instructions for putting your exquisitely manicured foot forward. It not only tells you what not do with very relatable examples, it explains in just 18 pages how to optimize your social media to the benefit of your career.”

Dr Ifeoma Ndigwe

How to avoid unethical conduct on social media

This instructional manual details how transformation in technology especially in our social engagements has fed directly into the practice of modern health care; shedding light on its mismanagement and how to make the best of this modern innovation.

Considering the misconduct of health services in social media spheres, this book aptly brings to one’s remembrance the oft-ignored moral codes that form the pillars of medicine as a discipline. The information therein is all-encompassing, easy to understand and addressed in relatable social media colloquialisms.

It also properly recognizes and delineates the nuances in the different social media platforms. By illustrating actual examples of some gaffes, it brings to life the reality of this trend. I must commend the effort put into bringing this to fruition. It is an important recommendation for all health care workers: the social media savvy and naive alike.


Dr Balogun D.I

Illustrations of improper conduct

Social Media Usage for Health Workers is an easy-to-read guide. I like the way Mariam Toye and her team make it so relatable, giving examples which are very relatable and ethical dos and donts which are easy to understand and follow.

Medicine is a delicate profession where you would want to be mindful of what you say to protect the Identity of your patient but at the same time use this New Age Avenue/Market, which is “The Social Media” to educate the public. So, if you don’t want to say anything online that you wouldn’t want plastered to your face on a billboard like Erin Bury says; as a health professional, please use this guide!”

Dr Rebecca Solomon

What Exactly is Lupus? – 10 facts to mark World Lupus Day

Goodreads review

“Am I dead yet,”…Diagnosed during her high school years, the author decided to keep a personal diary of her confusion,

fear, and challenges of being diagnosed with Lupus. Lupus, also known as Systemic Lupus Erythematosus (SLE) is a

disease that can affect many different body systems, including the joints, skin, kidneys, blood cells, heart, and lungs.

Facts about LUPUS

1.Full meaning Systemic Lupus Erythematosus or SLE

2. It is an inflammatory autoimmune disease caused by genetic abnormalities.. This means that the body’s defence attacks

its own cells, tissues and organs.

3. Women are affected in 90% of cases.

4. Symptoms include feeling of unwellness, fatigue, fever, rash, joint pain, loss of appetite and weight loss.

5. Its rash is unique in the way it spreads, flatly across the bridge of the nose and cheeks in a butterfly pattern.

Hence the symbol on campaign posters.

6. SLE causes damage to the kidneys, heart, nervous system and other organs.

7. People affected experience intervals of wellness and this is part of why the ongoing damage to vital organs

becomes life-threatening.

8. Doctors make a diagnosis of lupus with the presence of 11 criteria

9. Treatment involves medication to reduce inflammation, steroids and in severe cases, chemotherapy.

This is carried out by a specialist who is called a rheumatologist.

10. People living with SLE can reduce the severity of symptoms and progression of the disease by avoiding

direct contact with sunlight, using their medication as prescribed and seeing their doctor for close monitoring.

.

If you learnt something new from this post, kindly share.

Dr Mariam Toye

Founder and Editor at OumissaInspire

Collaboration, The Key to Healthcare Reform in Nigeria

Image Source- Nigeria Health Watch

The healthcare sector in Nigeria is in need of urgent development. Only when this change is led by the most influential players can the results be tangible. Titans of the industry and stakeholders from other sectors of the economy came together in Lagos recently to deliberate on solutions based on the public-private partnership model. The policy dialogue tagged ‘Disrupting Healthcare: PPPs As A Model For Health System Strengthening In Nigeria’ was organized by Nigeria Health Watch and PharmAccess group, two bodies improving access to healthcare in Nigeria using advocacy and technical assistance respectively.
Through partnerships, international organizations have rehabilitated health centres that had hitherto been operating below par. Most of this effort is targeted at the primary care level which is the first contact for eighty per cent of the population.

Nevertheless, health transformation is a struggle that must be undertaken across different levels. Much emphasis was placed on the new idea that for it to be sustainable, healthcare must be run as a business and not a social service.

Simple yet effective solutions like clean water and sanitation will yield the remarkable results in a country where forty-six million citizens stool in public. Currently, there is the binary option of care with the rich accessing the best available care and the rest of the country scrambling for what is left. The level of care in some primary healthcare centres is tragic. Quality is, therefore, a key element of viable healthcare PPPs.
There were two panel discussions with members from government and private institutions. The first emphasized the need for a stronger influence by doctors and other health stakeholders to push for reform at the federal level. The masses are more likely to protest against fuel price hikes but this energy is not reserved for another vital aspect of life- the dismal healthcare obtainable in many parts of the country.

It was also noted that the nation is in dire need of more health economists, health finance experts to formulate policy in the various health ministries. The current situation where every decision is made by only doctors whose training sadly often doesn’t include these fields will not help us achieve our goals.

Panel Session 1

Panel Session 1Session 1: Mr Voke Oshevire, Executive Director, Dr Ola Orekunrin-Brown, CEO, Flying Doctors Nigeria. Dr Jide Idris, Commissioner for Health, Lagos State. Mr Anthony Abou Nader, CEO, Tanit Medical Engineering. Dr Olaokun Soyinka, Director, Independent Verification Agent for Saving One Million Lives Nigeria. JNC International Ltd. Mr Abiodun Amokomowo CEO, Ibile Holdings Limited. Mr Felix Ezeh, Investment Executive, GroFin.
According to a recent TechCabal report on health tech sector, there are over eighty health tech companies in Nigeria providing solutions to a myriad of problems. Unfortunately, many entrepreneurs often lack access to financing and incentives to scale their companies. Creating an option for medical or premise licenses to be used as collateral was put forward.

Contrary to popular belief, finance is not limited to cash but includes personnel, material, endowments, real estate. It is imperative we are open to options and not be myopic. Patience is required of all involved for the process often isn’t an overnight one. Available resources must be maximized as wastage poses a huge threat to the proper utilization of allocated funds.

The true measure of a community’s health is the quality of its maternal care. –Dr Ifeanyi Nsofor

Government initiatives put in place through the Basic Health care Fund include those that simplify the payment process for people in need of care. The banking sector is contributing to healthcare by improving access to funds, educating providers on the cost benefits of establishing optimal services and facilitating partnerships. They also help health facilities bring their accounting systems to standard, provide flexible payment models and ensure controls are put in place to tackle the lack of trust.
In between the discussions were documentaries highlighting different missions to underserved areas showing the drastic impact personnel and cash financing bring to underserved communities, many of which are remote. Through initiatives like hospital camps, free emergency surgeries, education and health insurance; the quality of life in these communities was vastly improved with the joint efforts of PharmAccess and Toronto Hospital, local and state governments.

Panel Session 2

Panel Session 2

Session 2: Dr Tayo Lawal, Permanent Secretary, Lagos Primary Healthcare Board. Mrs Clare Omatseye, President, Healthcare Federation of Nigeria and Founder, JNCI. Dr Ben Nkechika, DG Delta State Contributory Health Commission. Dr Jide Idris, Commissioner for Health, Lagos. Prof Chris Bode, Chief Medical Director, Lagos University Teaching Hospital. Dr Oyebanji Filani, Senior Technical Assistant, Hon Minister for Health. Engr Chidi Izuwah DG/CEO, Infrastructure Concession Regulatory Commission.

Distrust of digital health records is rife in many centres necessitating gradual implementation and compromise. Pregnancy should not be an emergency as there is ample time to plan for childbirth. The absurdity of the current risk associated must be communicated with all members of the community. Mobile health clinics can be used in some areas to provide care and this circumvents the huge cost of facilities. These are a few examples of the unconventional options being applied in interventions across the country. In addition, adapting from a wide variety of working health systems worldwide to our local context will help us move closer to the desired level of development.
Nigerians spend millions of dollars on healthcare abroad. This amount is comparable to the health budget. This is a symptom of a deeper problem! Efforts need to be amped to ensure the working conditions here are brought to standard if we are serious about stemming the current tide of brain drain and haemorrhaging of funds to countries with better health systems. While some level of specialized care is available, most Nigerians do not know about it or trust it.

Documentary
Documentary

The onus is on us to build and maintain world class institutions to keep our health professionals, patients and money at home. To achieve this, the expertise and management of the private sector should be combined with the infrastructure and political will of the public sector. The distrust that currently exists between them can be mitigated by putting quality control in place. Within the private sector itself, collaboration rather than competition should be the watchword. This will help the health sector to be unified force and voice at the policy-making table for lasting progress.

The future is so bright, you are going to need sunglasses.

Mrs Clare Omatseye

On the bone of contetion that is health insurance in Nigeria, theappalling extent of coverage ofe constitues a barrier to providing universal health care. This has left the crowdfunding method of health financing as the only hope of many in need of expensive care. The estimates hover around one to five percent. Only twenty-eight states have a legal framework for health insurance with some like Lagos and Osun implementing state level schemes.

Through public-private partnership, government centres have been outsourced to the private sector with improved efficiency of service delivery, a marked reduction in mortality, increased profits and sustainability. Adequate communication at all levels with all stakeholders is however crucial to the success of these models as there exists cynicism towards it. Infrastructural gaps have been filled.

It is reassuring to see many stakeholders working and committing to improving the Nigerian health sector. Hopefully, these forged partnerships yield measurable results soon. To achieve the phenomenal change needed, we must be ready to disrupt!

Dr Mariam Toye

Of Prevention and Cures – Fighting Cervical Cancer



On either side of the Atlantic, two passionate individuals are taking the fight to cervical cancer. Both are women, have earned the Dr. title and are working tirelessly to save women from a preventable killer disease. What is particularly intriguing is the possibility that neither of them has met the other but are using different means to achieve a common goal; saving lives. These two are a source of inspiration for many. More crucially, they have become role models for millions of young women in developing countries and will motivate them to take up careers in STEM.Two days ago, the UN marked itsInternational Day for Women and Girls in Science.
For centuries, the immense contribution of women to science has been obscured. It is both illuminating and painful to discover advances in physics, chemistry, mathematics, health, programming, space science etc made or contributed to by women whose names have been buried in the footnotes. It is therefore imperative to celebrate those in our time doing such revolutionary work.


Meet our Women Crush Wednesday: Dr Onyedikachi Chioma Nwakanma and Dr Eva Ramon Gallegos.




Dr Nwakanma is a Nigerian doctor using storytelling for health advocacy. She is one of the foremost health advocates in a country where lack of health information increases the burden of disease and leads to thousands of death. She is a strong campaigner for cervical cancer awareness providing prevention, screening and treatment information to half a million people online.











Her impact is not restricted to the intricate highways of the internet. She is as tireless offline where she works on a variety of health programs. She organizes free health outreaches taking quality healthcare to underserved communities. Earlier today, Her Smile With Me NGO carried out a successful free cervical cancer screening program for hundreds of women in Lagos and Abia states. You can find her here on Twitter.




Dr Eva Ramon Gallegos is a Mexican scientist who has been working for two decades to find a cure for human papillomavirus, the pathogen implicated as the known cause of cervical cancer. She is a researcher at the National Polytechnic Institute. How does one keep up such determination and hope for that long? Many would have been discouraged but Dr Gallegos trudged on until a couple of days ago, she achieved her dream. Using photodynamic therapy, she and her team completely eliminated HPV in 29 infected patients. This article details the groundbreaking achievement that we must celebrate given its potential of saving millions of women.



We have a personal interest in this disease and thus all efforts and news like this make us jump for joy. It has always bothered us that something that can be easily treated and prevented still kills so many women. It feels like rainbows to know we now have a cure for the causative infection. There are valid concerns that historically, medical science has not given equal importance to women’s health. It is therefore of striking significance when women achieve feats that close that gap. This cure needs to be made accessible globally so it reaches those who need it the most.


To all the nerds and geeks out there you rock! Your work saves lives and its impact is felt around the world. To all who are working on an innovative solution to the problems facing us, hang in there and be patient. Learn from Dr Gallegos- stay strong, believe in your dream no matter what, keep working at it and don’t accept defeat.

The world awaits your work.

Oumissa,
Lagos Nigeria,
130219