Monday, July 29, 2019

Nigeria -- How Dysfunctional?

"Previously, our studies showed that the tramadol use was relatively low among our drug users, at about four percent, but as of 2014, about 45 percent of all clients referred to this facility were using it."
"We understand that some of those taken captive by Boko Haram or who have fought with the group are given the drug to numb their feelings. We've had soldiers brought in for addiction treatment as well."
Dr. Ibrahim Abdu Wakawa, director, Neuropsychiatric Hospital, Maiduguri, Nigeria

"At first, tramadol just makes you feel good and full or energy, taking all your body aches away."
"But soon I needed to take it all the time. My family made me come here, but when I realized I wasn't going to be able to get tramadol any more I became very aggressive."
"I'm clean now, but I kept a diary of my treatment to remind of how bad things got."
Ahmed Muhammed, in-patient, Neuropsychiatric Hospital

"At first they just helped me to forget the trauma of the attack [by Boko Haram in Bama], and how we had to run for our lives."
But now I take them for other reasons too: just to blot out the pain of life here in Nigeria, the boredom and hopelessness. My consumption has rocketed."
"I could get some right now if I wanted. There is a dealing spot just around the corner."
Abel Habila, Maiduguri, Nigeria
Nigeria is facing catastrophic levels of opioid addiction — and no one seems to know how to stop it.

Nigeria is the largest, most populous country in Africa. It has oil wealth. The population is divided between Christians and Muslims. And it is wracked by Islamist terrorism. In northeast Nigeria Boko Haram wreaks havoc, invading villages, burning homes, murdering people, raping, abducting school girls. Despite its wealth and its large military, succeeding governments have been unable to arrest the terrorism. Its soldiers are ill equipped with outdated weapons and are ill trained and poorly motivated.

For a country with a lot of potential to advance on the scale of national achievements in technological progress, economic balance, decent employment and educational opportunities, and above all, national security, corruption reigns supreme, leaving the population insecure and fearful, and riven with sectarian and tribal rivalries. Perhaps it is not surprising that an epidemic of opioid addiction is further roiling the country.

It is, after all, a epidemic of notable proportions making its dreadful way through countries with advanced economies, full employment, excellent public security and national wealth in democratic settings where opioid overdoses have become a public emergency. In Nigeria, the abuse of tramadol, meant as a prescribed pain reliever has become universal. Farm labourers, rickshaw drivers, college students all use it to energize themselves in the belief that its useful properties outweigh any negatives.

The negatives of prolonged use: seizures, psychosis, fatal overdoses -- and withdrawal symptoms can re-introduce the avid user to the very same kind of physical pain that tramadol is meant to treat. There is a wider substance abuse epidemic in Nigeria, with close to 15 percent of its 200 million people reporting a "considerable level" of psychoactive drug abuse, representing three times the global average.

Customs agents seize hundreds of millions of tablets, mostly imported illegally from Asian manufacturers. The black market price for the drug has risen twenty-fold since the Nigerian government ordered tramadol prescription-available only. Even with that, a single 200mg capsule costs under $1.60. The World Health Organization is reluctant to place tighter international controls on the trade in tramadol, arguing it would take out of circulation one of the few inexpensive painkillers hospitals and clinics in Africa can access.

Despite the scale of the crisis, there is little help for opioid addicts in Nigeria
Despite the scale of the crisis, there is little help for opioid addicts in Nigeria   The Telegraph

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Saturday, June 23, 2018

The Healing Arts

"There was a disregard for human life and a culture of shortening the lives of a large number of patients by prescribing and administering 'dangerous doses' of a hazardous combination of medication not clinically indicated or justified."
"[Records show that] whereas a large number of patients and their relatives understood that their admission to the hospital was for either rehabilitation or respite care, they were, in effect, put on a terminal care pathway."
"[Dr. Jane Barton was] responsible for the practice of prescribing which prevailed on the wards."
Bishop James Jones, chairman, enquiry panel
Dr Jane Barton
Dr Jane Barton worked at the hospital for 12 years. Photograph: Chris Ison/PA

Found guilty of "multiple instances of serious professional misconduct" in 2010 by the General Medical Council of Great Britain, this woman who institutionalized the practise of administering opioids without medical justification in the British hospital she headed, retired soon afterward. It was, however, the deep and lasting harm she imposed on vulnerable and ill seniors brought to the hospital in the belief by family members that their loved ones would be safe and well looked after, that marks her name with infamy.

Hospital senior management, health-care organizations, police, prosecutors, local politicians and medical authorities all had failed in their civil-social and professional duties to ensure patients were protected and were found responsible when their interests were "subordinated to the reputation of the hospital and the professions involved."  "They have grossly failed their ethical standards by abusing people's human rights [in view of] vulnerable relatives who were stripped of their final words to their loved ones, silenced by overdoses", accused the granddaughter of one victim.

Gosport War Memorial Hospital in southern England underwent a rigorous three-year investigation of its practices between the years 1989 and 2000 to account for 833 death certificates signed by Dr. Barton. Over a million pages of documents were examined leaving the enquiry with the conclusion that 456 patients lived lives shorter than they should have, with an additional 200 more "probably" similarly affected.

In very point of fact, two hospital nurses made an effort to raise the issue expressing their concerns 27 years ago in 1991 with respect to prescribing practices that troubled them. Those two nurses' concerns were ignored, leaving them "ostracized" in the workplace. The panel of enquiry found inappropriate use of opioids began in 1989, steadily increasing until 1994 when the practise plateaued until a decade later then rapidly declined. No additional cases were reported in 2001.

Many deaths might have been avoided had the hospital treated the nurses' concerns seriously.

Medication prescribed by Dr. Barton had contributed to six patients' death according to inquests conducted in 2009 and 2013. The panel was exposed to comments about her "brusque, unfriendly and indifferent manner, her "intransigence and worrying lack of insight", into effects her actions resulted in, along with her inability to "recognize the limits of her professional competence".

Medical records confirm that over a twelve-year period as clinical assistant Dr. Barton was responsible for and central to "prescribing any medication required". As for the police; family members were treated as though they were troublemakers by investigators who deferred too much to the hospital.

Families of those who have died at Gosport Memorial Hospital
Families of those who have died at Gosport Memorial Hospital gathered at Portsmouth Cathedral to hear the findings of the inquiry   BBC News

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