What got me
fascinated and interested in cycling was the story of one man, Lance Armstrong, he
recovered from testicular cancer and went on to win 7 consecutive Tour de
France titles. That was the story, there is life after cancer.
When I then had life-threatening
cancer in 2009, after months of denial, at the point of acceptance, I began to
believe there is a life for me beyond my ordeal. That Lance Armstrong was then
found out to be a drug cheat and stripped of his titles is unfortunate, but
that is not the story that resonated with us, cancer survivors.
Indeed, one can die with
great integrity and be eulogised quite ordinarily, or die having achieved
notoriety, ignominy, and even disgrace, but with a life to live there is some
opportunity for redemption if it comes. If it does not, you are still there for
the ones you love and still love you and that for me is an extraordinary story.
Lance Armstrong as a person remains a hero.
Medicine for the race
As the world
unravelled around him, the mantel fell to the UK to retrieve the reputation of
cycling from the dust. In track and road cycling, at the Olympics and peloton Grand Tours,
cyclists from the UK took golds and titles, we were cheering from the rafters
and men rose from their knee to become knights of the realm.
Great men like those
of old, men of chivalry rescuing damsels from distress. Erm, well, there was a Dr Richard
Freeman, the team doctor meant to see to the medical needs of the cycling teams
and in his position would have been able to acquire medicaments to treat all
sorts of conditions. Saddle soreness, for example, and anything in that region
that might need attention.
Challenges of manhood
He however
highlighted one condition about a male head coach that drew recriminations and
rebuttals. You can challenge a man about many things, but not his manhood and
its efficacy at performance and surely not in a public forum. Yet, Dr Freeman
will have us believe that he ordered 30 sachets of testosterone to help Shane
Sutton with his erectile dysfunction. I am a tyro, but I thought you got Viagra
or Kamagra for that, but what do I know?
Anyway, with that
order comes the possible taint of the achievements of the British cyclist,
though, meanwhile, Dr Freeman, free with words, free with the truth has been
freed from medical practice. Sadly, he might have set the peloton in
dysfunction.
When I opened the packet of my new medication just over three weeks ago, reading through the medical notes was an experience in itself. Then, I had to tear off a “Patient Alert Card”, to which I wrote in my doctor’s details and was at all times to carry the card with me.
If I were to have a hypersensitive reaction, I was not to ingest any more of the medicine as I risked a life-threatening lowering of my blood pressure or even death. Before I took the medication for the first time, I already had the severe side-effect of a psychological upset.
Having done my research of the options, it is fair to say that the documented side-effects are a compendium of misery, it is no wonder that it is reported that the attrition rate of switching back to old formulary is close to 50%.
I needed another review
I kept a diary of the side-effects I suffered over a period of 16 days before our first review that was to completely switch me fully to the new medication for the next 6 months before another consultation. I did not think 16 days was long enough to make that decision, as adjusting to new medication would normally take longer and I would rather we had an assessment to ascertain the efficacy of the new regime than to discover a treatment failure 6 months hence.
The side-effects included insomnia, a tingling skin rash, a feeling of constipation, joint ache and flatulence amongst other minor complaints and two episodes of vivid dreams as nightmares that left me unable to sleep for the rest of the night.
At the review, I was asked why I made the switch as I was seeing another medical personnel who did not know that I had been nagged by the department to consider a switch for almost two years. My understanding was the switch was necessary because this new line of drugs had lesser side-effects and obviously they cost less.
What kind of a pill is this?
I was comfortable with the medication I have been on for over 8 years, the issues I had with my memory were well compensated for, I would not have considered a switch for the kinds of side-effects that I have recently suffered. Bloods were drawn and we agreed to meet in three weeks for a second review.
Meanwhile, I am taking my pills 2 hours earlier than before with no change to many of the side-effects, especially insomnia. I am also keeping my diary as a documented trail of how I feel, which is not helped by my realising that I am gaining weight – apparently, this is one of the other side-effects and no new medication is worthwhile if psychologically you are left bothered by a negative body image, the danger of sudden death and much else.
I have known hospitals from the very first day of my life that they do not seem that strange to me, but many a place have I been that it might not be as welcoming as to make one feel well.
In the last few weeks, I have 4 visits, check-ups, assessments, observations and talks, some could well be unsettling if not for a rather calm exterior. For it, all began with a suspicion, whether a growth, she could not tell, but it came with a referral.
Meanwhile, in another place we had a discussion for a change of medication, in my research, of the 4 options presented, none seemed like a safe transition as the listed side-effects were fearsomely avoidable if one just stuck to what one was already on for 8 years already.
Yet, they say, these are newer efficacious drugs, but the news out there suggests over 50% have returned to their original medication just because of the side effects.
A belly prod
At the referral, I could not say the consultant was pleasant. Much as I was invited to see another consultant who I had read up on, the one I saw had a bedside manner that served me lots of discomfort. The hand I offered was not taken and the introduction was mumbled or maybe I had suddenly become hard of hearing.
He referenced the notes, asked a few questions and then had me on the gurney but called in a chaperone nurse before he did anything. For God’s sake, I have been violated by medicine too many times to be concerned by a poke, prod or prick, but needs must for all the reasons in the world.
I felt no pain as his hands did the feeling all around my abdomen and elsewhere before I dressed up and he returned to the desk to scribble away. He was recommending a colonoscopy and a phlebotomy, whilst I was thinking, I would rather be with the people who know a lot more about me.
Pills of life
Then we decided, that was the best, it means my doctor who over almost three years has collected sheaves of medical material about me, but I have never met would be arranging for me to visit a department of probing analysts.
In all, I am now in new medication for which the side-effects have not been that serious, we would review the situation next week, at which point it might well be a full transition. My medication comes in a little box with a difference, I found I had to peel off a card that suggested certain side-effects could be life-threatening. Now, that is scary stuff. I have to travel with a card listing my doctor’s details.
I chose this because it offered no change in pill burden or mode of consumption, I could still take it at the same time as with my old pills and now, with or without meals. If I do suffer pyrexia; a medical type for having a fever, have a skin rash which might well be invisible considering, have shortness of breath, feel queasy, have a sore throat or a cough, I should consult my doctor immediately.
Just writing all that makes me feel unwell, but I thrive. Now, what is an umbilical hernia? That came from the prodding and poking. Whilst I protest that it is my body first before it is anyone’s guinea pig, sometimes, I find myself the latter, just because I am the former.
Wednesday could only have been termed brutal in more ways than one, I returned home from the hospital and just went straight to bed to sleep off the feeling.
It was my biennial check-up, the one I was prepared to go for a month ago, only to realise that it was a month later. I got my appointment card and called an Uber cab to take me to the hospital and that is where my physiological problems began.
The Uber driver in the quest to cut out traffic ran into road blocks and other traffic that the 40-minute leeway I gave to getting to the hospital was being eaten up that I was getting anxious. The journey only takes 20 minutes, I arrived, just in time.
The pressure of the world
Then through the labyrinthic corridors to the Out-Patients’, I wended my way, half-hobbling and almost reduced to panting when at the reception I realised that I had forgotten to put my appointment card and treatment journal in my pocket. Though I did not need that to identify myself, I was at that point flustered when I was directed to sit in the waiting area.
Minutes later, I was called in for a weighing and blood pressure assessment. My weight has been going down, but the numbers that came up for my blood pressure were astronomical, both the systolic and diastolic measures in the 3 figures.
We tried the other arm, but I was already in a state, the numbers did not radically change. The nurse opined as did the doctor later on that certain patients have a white-coat syndrome that heightens their blood pressure in a hospital setting and that hospitals are rarely the best place to take blood pressure measurements.
A doctor I miss
I did not think I had a white-coat syndrome, I have known the inside of hospitals from the day I was born, there had to be other factors. My little sleep, the Uber ride, my forgetfulness and any other factor that is as yet undetermined. I did measure my blood pressure in the relaxed setting of my home yesterday and the numbers looked within the ranges of normal.
I was meeting the doctor for the first time, he introduced himself as a registrar, I have lost count of the different faces that make up this department. The head of this department when I first attended this hospital some two years ago, an affable and friendly man with a gentlemanly mien and comforting bedside manner had retired and was out in Burma doing charity work. I last saw him in October and he was the one who suggested I had a big do for my 50th birthday.
Then I had had the opportunity to research the incoming head before I met her in the middle of the last year, we got on quite well. However, as the new doctor began to go through my notes, his apparently calming assurances left me in more discomfort and anxiety than I have ever felt meeting consultants in the last 8 years.
The whole works and working over
Maybe it was a confluence of events, but by the time I had seen a few more unpronounceable names to do with my liver, my kidneys, my gall bladder and my bile ducts, none of which on further research back home presented an alarming set of circumstances, I felt like I had gone in for acne and ended up in intensive care.
He was being thorough, at least that is what he told me and invariably, my drug regime might be modified in 6 months’ time based on cost, and I have a battery of tests to follow, bloods, liver scan, cognitive impairment and a ‘non-judgemental’ review of my sex life. Then he put my numbers through QRISK to determine my susceptibility to cardiovascular disease within the next 10 years and having stopped smoking 33 years ago, I was denoted an ex-smoker rather than a non-smoker; technically, he was right and thorough, if not pedantic. It was the full works and brutal.
I took copious notes and at the end, we did not even have a customary handshake before he was out to pick up the notes for the next victim, sorry, patient.
That was brutal
I put in my prescriptions at the pharmacy and joined the long queue at the phlebotomist’s, where a bit of gallows humour appeared to lighten up the day. When someone asked if they had lunch breaks, I quipped as to whether vampires ever took breaks from bloodsucking.
When I finally got home, I just went to bed, too much had happened in such a short day. Yes, it was brutal, by all standards. I am not looking forward to meeting this doctor again and it is probably nothing to do with him, I was just completely ill at ease chatting to him.
Generally, one is rarely inspired to write about this topic, but there comes a time when something does need to be said, and my blog is a forum for such when it matters.
As a minority of many facets in living and thankfully thriving within a majority of diversity, the greatest triumph of the person is to be comfortable in one’s own skin when met with the various indignities that are doled out by the ignorant and those who should know better either at work or at play.
The indignities are many
The fine line between being patronised and being belittled in the corny device of faint praise or acknowledgement is constantly being crossed and with great restraint and the discipline that comes with rearing and bearing, one would bat off, ignore or challenge the infraction to ensure that such unhealthy encounters do not become the norm.
Earlier this evening, I was met with such an encounter from a stranger who no doubt had grown his knowledge of people like me from some odious script or noxious experience that I cannot care to be concerned about.
It is without doubt that one along with many like me; and I mean black men, in this case, have suffered such indignities and disrespect that demands a response in rage, but elicits the riposte of a polite put down, if a monosyllabic retort will not do the job as efficiently as one would desire.
Nonsensical stereotyping
By enquiry, I received a message with the subject heading, ‘Busy?’, the body of the letter read thus;
“Hi, weird question. I really wanna get some weed tonight. Can you help me babe? Xx”
Let us not belabour ourselves with the many issues with address and import, the context was layered on like a slice of toast so heavily buttered, its falling from any height would create an oily splatter and there could only be one response and I quote it below:
“Hello, Just because I am a black man does not mean I do drugs, deal drugs or know a dealer. I am a highly placed professional and I have had enough of this nonsensical stereotyping from the drug-addled lot that have no gumption beyond seeking the pleasure of illicit highs. I have seriously restrained myself from the needed use of an expletive to tell you off totally. Regards.”
Just too many times already
Now, you may ask, what would elicit this kind of response and the answer is in a long history of encounters of a similar kind. A stranger sidles up to me in some public place or writes to me in some social forum and for some reason or the other which I dare say can only be borne of some stereotype or the atrocity racial profiling, asks if I have drugs or know a drug dealer.
The misfortune if that is what one could generously call it is my life and many others I know are not true to that stereotype or that profile. We have through many determined and fortunate turns in life lived and enjoyed privileges that is the substance of the dreams of others. Not that we have to wear such luck around our necks and rattle those blessings with the aplomb of the arriviste; understated remains the quiet class of discretion.
It must stop
However, after a holiday in Spain, where for almost the umpteenth time, one was unwittingly besmirched with the odium of trading in illicit and illegal substances, the usual silence now demands a more forceful response.
Yes, we are black, no we do not use drugs, we do not have drug dealers as friends and honestly, stop asking a black person anywhere whether they can acquire drugs for you. The simple inquiry for your inordinate pleasure is to the other person, a badly served slight and insult, we would overlook such abuse no more.
I did not expect today to be as difficult to cope with as the last time I was in hospital to have a FibroScan and it wasn’t.
All sorts of tests needs to be done to check on health of the liver, from liver function tests that are derived from blood tests, through the FibroScan to check for liver fibrosis and today, it was the turn of an ultrasound scan of my liver to check for scarring on the liver.
The instructions for today were not to have had any meals for at least 6 hours before the scans, however, because the appointment was in the morning, it meant I was not suffering as much as when I had to do with meals for 2 hours, but the appointment was for the early afternoon.
After attending one of the many almost pointless talk shop telephone conferences, a forum for the deluge of conversation with the aim of achieving something much longer than if everyone just instinctively and assiduously got on with what they need to do, I got dressed and called UberXL.
The driver arrived and whilst his name looked Turkish, he revealed that he was from Eritrea and there begun a discussion about power crazy leaders whose penchant for war over peace had led to the unnecessary demise of Africans fleeing conflict.
Then, I told him where I was from and where I had lived. When I mentioned the Netherlands, he expressed reservations about how safe Holland was for children because of the Red Light District and the coffee shops.
What we never talk about
First, I gave him some insight into Dutch thinking, the realisation that we are prone to vices and whether legal or not, people will indulge in their needs for sex and drugs, they will also pay for such if they need to. In Holland, the Dutch have provided a ‘safe’ and regulated framework within which prostitution can be practiced and drugs procured legally. He got that.
On the matter of children’s safety, I tried to make a difference between instruction and education, stressing that children need more involved parental education on the realities of life so that children can end up making wise choices.
For instance, I said, if my parents had discussed sex with me and clearly indicated that if I was touched in certain parts of my anatomy, it was wrong and I should come and tell them, it is unlikely I would have silently suffered any child sexual abuse. There are more things effective parent communication on the issues of life and experience that could have been discussed and saved the child the misery of bad choices and worse.
Our different experiences
Parents again sometimes fail to realise that the cultural environment in which they were reared as children and grew up in could be so radically different from that of their wards. Failing to adapt and reconcile might well leave the kids in a somewhat schizophrenic world of home life that has no semblance to street life; their encounters in school, with friends or in social settings. It ends up a disservice to the child and could be damaging in the long-term.
It is no appeal to abandon our traditions, but we cannot recreate little Nigerias, little Eritreas, or little Pakistans abroad and expect them to pass for the new realities of our nostalgic feelings for home than we can pass on to our children. Where we live moves on and where we left has also moved on, we are then caught with fossilised expressions of things that no more exist.
My UberXL driver could begin to see my point, we all reach back to our experiences back home in our childhood and castigate the realities we now exist in because we have refused to integrate at first and then aim to claim cultural superiority of our host cultures, thereby depriving our children of the essential education they need to thrive better than we ever have done here.
Our conversation ended as we drew up to the hospital, each of us having been challenged of the need to take a more liberal view of where we now belong.
The deceptions of receptions
At the main reception, I asked for directions to the X-Ray department, and much as there are many signs to the various departments in the hospital, it is a labyrinthine maze of corridors that taking directions beyond the third left or right turn is bound to get you lost in the morgue.
I found the section reading the signs and submitted my appointment notice to the section receptionist whose fast-talking demeanour completely threw me that I did not get to answer all her questions of name, date of birth and home address. I faltered giving my home address, it was not comfortable.
Then she made a mistake of ticking off the wrong name on the appointments list before properly searching for my appointment and ticking that off.
People like me
I was asked to sit and wait to be called. Most of the seats about 7 abreast per row were in theatre-like formation some 6 rows deep and then the wall to both the right and the front had one long row of seats facing us.
Many of the people occupied the seats in the theatre-like area apart from one middle-aged African woman, from what I could make of her features who sat alone to the right finding spiritual solace in the pages of her bible. Some others had the company of friends or relations as I made to sit amongst the crowd.
Just as I tucked into my bag to retrieve my tablet to make notes of my observations so far, a nurse called out my name. I arrived some 15 minutes before my appointment and was being seen to ahead of schedule.
Quite like yoga
We walked another labyrinth of corridors to the ultrasound equipment room where another nurse was busy on a computer to the foot of the bed. The ultrasound machine was against the wall to the left with the bed between us.
I was asked to take off my coats, pull up my shirt and lie on my back facing up for observation. The nurse then said she had to dim the lights in the room before commencing the ultrasound scans. I quipped in the words of a Bob Marley song, “Turn the lights down low,” to which she said, that was as far as the excitement will get. I remonstrated that she was a spoilsport and we all laughed.
She applied some gel to my stomach having warned me that is was warm, a stark contrast to the gel applied to my sides for the FibroScan that was cold enough to send me into hypothermic shock.
The probe was pressed against my skin and she started taking shots of my liver, from the front, from the right side, from the back and then slightly to the left. I asked if it was kicking, it brought a chuckle to all of us as she answered, it was.
In all this, I was instructed to breathe in, hold my breath, breathe normally and push out my stomach and this went on for almost 15 minutes. I could well have been in yoga classes for all those breathing exercises.
A short story
When we finished, a good deal of gel had smeared my shirt, but it washes off easily, I was told. There was time for an anecdote or short story related to pulling out a yellow plug at the end of the day. It was a short film starring Omar Sharif as a taxi driver taking a passenger to a cosmetic surgery hospital.
They passed by another major hospital that had been closed due to unfortunate circumstances, the case of unexplained deaths that damaged the reputation of a once renowned establishment. People in intensive care were dying overnight and some night doctors were about to be charged, being suspected of murder.
Eventually, they installed video cameras in the intensive care wards and it transpired that at 1:00AM the cleaning lady when into the room with her vacuum cleaner and simply pulled the plug of the life support machine to gain a socket to plug in her vacuum cleaner. The horror!
Hospitals now have tamper-proof plugs for critical equipment or red notices posted that such equipment should never be disconnected.
I left in high spirits after being told again that my liver looks fine, but I will get the full detail from my consultant when we meet at the end of next month. I was home just before noon.
The stats may not be
fully known, but the estimates are in the millions of those who have gone by
reason of AIDS. Big names, somebodies, 'any
bodies', nobodies, the first two probably knowing and finding some respite maybe
in medicine to arrest the rampaging HIV that presents AIDS.
The 'any bodies' are those who probably do not know that they have HIV and might well learn that they have it when they have developed AIDS. Yet not all hope is lost, people with medical intervention have come back from the life-threatening claws of AIDS to live lives just affected by HIV.
The nobodies however
are those who have despite knowledge of their conditions neither have access to
treatments, monitoring or drugs to arrest HIV and eventually succumb to AIDS.
Knowledge is progress
My view of the World AIDS Day is for the 'any bodies' and nobodies to become somebodies, people who know their status because they have access to be tested regularly. Who when tested have the counselling and information to make informed choices and if found to be HIV positive have access to medical expertise and drugs to live productive lives.
Being infected with
HIV does not have to be a life sentence, it is a manageable condition with easy
to use medication and a wealth of support and expertise that means no one has
to suffer alone.
Beyond this, we need to move beyond the stigma of HIV and AIDS. All sorts of circumstances might have brought on the disease by commission, omission, happenstance or accident, there is no need to be judged or be judgemental.
Knowing the truth
We also need to move
the management of HIV/AIDS out of the domain of desperation where charlatans,
snake-oil merchants and so-called faith healers prey on the vulnerable for
profit and fame.
HIV/AIDS is a medical condition, first and foremost; any assumed or considered change to that condition must always be assessed fully from a medical perspective. This is regardless of whether the person believes they are healed or they believe progression of the disease has been halted.
It is pertinent that
HIV/AIDS remains under the supervision of qualified medical personnel.
Know your life
And so, on this World
AIDS Day, this is what I advise.
·Know
your status and renew this knowledge at least every year. Get
TESTED regardless.
·If
your status indicates being HIV positive, seek immediate medical intervention,
you might be put on ARVs and these
drugs are usually free.
·Do
not for the fear of the knowledge of your status allow HIV to waste you away, there is abundant help for you to have a useful life.
·If
you have exposed yourself in unsafe activity, enquire if you can have
access to PrEP,
this like the morning after pill.
·We are all sexual beings, it is a natural human need. Do not be embarrassed about your sexual life that you deny yourself opportunities to live longer after you have discovered you have a sexually transmitted infection, no matter how minor it looks, seek help and remedy.
·Learn
more about HIV/AIDS
and know how to keep your health and yourself safe.
Maybe to my mind
that is the case, but there are possibilities that I have been in places where
I am probably the only ethnic minority for miles.
Now, it does not
bother me, though there seems to be an exotic and sometimes erotic quality to
my presence as curiosity and myth collude in a bizarre setting of becoming the
cynosure and object of interest.
This can be
comfortable as in where over 40 Turkish school children gathered round me for a
photograph in the amphitheatre of antiquity amongst the ruins of Ephesus to
where some young men with other interests appeared to sit with me for a picture
but had their hands in all my empty pockets.
Keep your valuables in your hotel
I am the wiser to
know that when going out at night never to take anything of value with me, the
list of those things includes passport, wallet, lots of money and most
particularly my mobile phone.
The mobile phone
which can be replaced is a lot more valuable than we realise, it contains address
books of contact details and information that cannot be easily retrieved as
pictures and certain utilities or application settings too important to be
without as banking apps, navigation tools and so on.
This became evident
last night when a lady, I used that word loosely, got herself so inebriated
that she became a victim of opportunistic crime. She lost both her money and
her mobile phone to one of the many who look for the vulnerable to exploit.
Spurting out expletive after expletive would not have changed the situation and
the more she railed, the less it made it to help her, I was saddened for her
sake.
No one should be a victim
of crime, whether vulnerable or not, yet, one cannot absolve the victim totally
from blame if a few precautions were taken as leaving valuables in the hotel
and drinking sensibly. The phone had much treasure pictures of her daughter,
but thieves are not people who place any value on anything we hold dear. The
phone would be pawned off for a pittance just because, I’ll leave it at that.
Impressions about black people
Back to what I
began with and I have not written about this before, the fact that regardless
of how open and free Europe appears to be, we are nowhere near a post-racial
society where stereotypes, prejudices and ascribed attitudes define how people
are viewed.
I cannot count the
number of times I have been approached by people who assume I have hard drugs
to peddle. The idea being that mainly what black people do, they do not have
conventional careers or professions but live on the edges of society fully
involved in some sort of criminality.
Where you wonder do
you begin to tackle this rotten misconception and image of people of my race,
many of us, honest, decent, upright and hopefully respectable members of
society and the communities with which we work and live?
Fuck Off!
So, this Swedish
couple approached me, the man sat beside me and then asked if I had smokes to
sell. When I responded in the negative, not only was he displeased, he intoned,
“Not good.” Basically, he genuinely expected me to be peddling drugs and never
expected me to be doing anything otherwise, it was obvious he approached me
because of my race rather than any other factor.
Somewhere in his
preconceptions, that is what we did. The slight and gravity of disrespect
seething with insidious racism was compounded by the fact not an apology was
offered for this effrontery of atrocious stereotyping.
I was half-angered
and I am minded to blurt out an uncharacteristic – Fuck Off! – When next I am
approached for drugs. Not my kind of expression, but it would be more than
effective in helping such idiots realise than we should be approached with
great caution, if the intention is to belittle us with association with
criminality rather than quality of character and better assumptions of status
and achievement.
We are nowhere near
a post-racial Europe, even for those of us with a very high self-esteem and
well-developed sense of self.
I cannot have
wished for more support and the honour showered on me with the 28 blogs that I
have already shared on my #YourBlogOnMyBlog Series
commemorating my Decade of Blogging. Four weeks with
just one more week to run in what I thought I might struggle to get blogs to
run until the end of December 2013.
Yet, it has been a
rather busy week that straddled the turning of the year from 2013 to 2014.
One news story on
Twitter about profligacy in Nigerian politics unleashed a torrent of tweets
that I collated into a blog with a backstory and context notes.
A demonstration of
the gift that I have come to know I possess was the poem that I crafted in 4
tweets over 12 minutes, the last verse of the Walk Away! poem coming much
later. Then a New Year’s Day blog recognising the gift and desire to do more
with it.
Funmi Iyanda gave a keynote address to a youth event challenging them to think differently if we are to change Nigeria and make it a better place. I added an introduction, put in some links and made some callouts to pertinent things she said.
This was very good
news, after months of indifference bordering on criminality, the system and
institutions responded to the cry of dying HIV/AIDS sufferers who had been
prescribed substandard drugs by government agencies.
NAFDAC withdrew all
the drugs manufactured by one company nationwide, replacing them with drugs
that hopefully will arrest the decline in health brought on by the usage of the
poorly manufactured drugs.
The theme this week
about life, pursuits, times, friendships, rights and history.
Here, for your
pleasure are four weeks of Decade Blogs. To everyone who has honoured me in
finding time to write for #YourBlogOnMyBlog, my thanks and
more. I would find the words of appreciation and gratitude, eventually and they
would still not be enough.
I am pleased to
read that the concerns raised about SubStandard HIV/AIDS ARV drugs have
registered with NAFDAC and they have taken appropriate action to suspend with immediate effect all the ARVs manufactured by Tyonex Nigeria Limited.
I first wrote about
this in November http://goo.gl/fYINqS
and then when I got hold of the said drugs in December I posted another blog
and wrote to NAFDAC about the issue http://goo.gl/kQOh8t
Obviously, NGOs
have been clamouring about this for months and to have a letter acting on the
issue is a very successful outcome for all those whose vulnerability has
somewhat been abused by failings in the drug administration system.
There is much work
to be done to build on this success, it is however wonderful news.
We have just
completed three weeks of my #YourBlogOnMyBlog Series, 21 blogs
commemorating my Decade of Blogging. Each blog that I
have reviewed, edited and written an introduction for has offered a showcase
into stories told by people with a voice so unique, yet one we can all relate
to.
I decided to stop taking blog contributions after I received 35 entries and I sent a personal message to the others who were not able to redeem their promises that it would have to be for another time, whilst thanking them for just considering and accepting the challenge.
The theme that
seems to define the third week is the significance of writing, in helping to
understand our humanity. Veterans and new comers to blogging displaying talent
and insight, I am so glad to share.
Here, for your
pleasure are three weeks of Decade Blogs. To everyone who has honoured me in
finding time to write for #YourBlogOnMyBlog, my thanks and
more. I would find the words of appreciation and gratitude, eventually and they
would still not be enough.
Just over a month ago, I wrote about the issue of sub-standard anti-retro viral drugs (ARVs) in Nigeria, and when some of my friends contacted people who were supposed to be in the know about the management and distribution of ARVs in Nigeria, they appeared to pooh-pooh the idea.
The message coming
back was that the complainers were not interested in using drugs manufactured in
Nigeria, that they wanted foreign-sourced drugs.
Handling the ARV drugs
Well, this
afternoon, I handled with my own hands the drugs, a bottle from India and
Nigeria of the same formulary of ARVs (Zidovudine [AZT] 300mg, Nevirapine 200mg, Lamivudine [3TC] 150mg), but
that is where the similarity ends.
It is important
that we clarify that the drugs are not fake, they are sub-standard, and I would
illustrate what I mean with pictures to follow.
The Indian
manufactured bottle is on the left, the Nigerian manufactured bottle is on the
right, and the first thing that you see is the poor quality of the labelling.
By comparison the shelf-life of the drugs is 35 months for the Indian version and 23 months for the Nigerian version – A first indication of a difference in quality or standards.
The question of Storage
The problem seems
to come down to information on this part of the bottle label. The Indian
version is to be stored below 30°C and protected from light and moisture, the
Nigerian version should be stored in a dry place below 25°C and protected from
sunlight.
A double-take to
the World Bank website for the average temperature and rainfall in Nigeria
and in India for the 110 years to 2009 suggests the average temperature in Nigeria only dips below 25°C in December and January, and it has a higher average range than that of India. [World
Bank Group][World
Bank Group]
Besides this, whilst
Nigeria does not have as much rain as the monsoons of India, the rainfall
is spread across more months suggesting the climate in Nigeria is broadly humid
resulting in more months of precipitation.
It goes without
saying from this basic observation that the instructions on the bottle of the
Nigerian manufacture ARVs must at least be the same as the ones for India – Store
at below 30°C, in dry place, protected from light and moisture.
Between English and French
It is also interesting to note the difference been the English and the French instructions on the Nigerian bottle. Apart from the typographical errors where the obvious one is physician spelt as pyhsician, why Anglophones should be concerned about sunlight and the Francophones are more affected by humidity, escapes me.
A French-speaking
observer of this said, “It is full of typos, and badly translated from English.”
In other words, this is patently shoddy work and that is just the labels on
bottles on life-saving medication.
With the permission,
my French-speaking friend, reviewed the French part of the label and his
comments appear below:
Chaque ma' dicament contient:
[...]
La prescription des pyhsician seulement. Gader tout medicament hors de la portes des enfants. Mettax su frais bas de 25°C. Protegez de l'humidite.
All the accents are missing and overall it
say on prescription only, keep away from children store below 25°C, protect from
humidity.
It does not make any reference to sunlight.
Why Tyonex could
not get a French speaker in Nigeria to properly translate the English portion
of the label to French escapes me. I am sure Google Translate would have done a
better job. It is unprofessional, shoddy and really dampening in confidence.
Inside the bottle
Opening the
bottles, the quality becomes evident, the Indian version has a desiccant, the Nigerian
version does not, the tablets or caplets as the label indicates are in a cling
film bag all coated with the white dusty powder of the pills.
The Indian version remains intact to the touch whilst the Nigerian version leaves a chalky residue on the fingers when touched and when held firmly between the thumb and a finger, it disintegrates as seen below.
I note that in the
blog I wrote last month, this is what the AIDS Healthcare Foundation said – ‘The
press
release suggests the drugs “are brittle, break easily and dissolve in
one's mouth before swallowing, and furthermore the package presentation is
substandard, with poor labelling that resembles the work of professional
counterfeit drugs peddlers.” [AIDS
Healthcare Foundation]’
The standards are poor
It goes without saying that poor manufacturing standards without consideration for the socio-economic and climate conditions in which the drugs would be used can inform the rapid deterioration of the medications leading to sub-par efficaciousness of the medicines, the consequences which can be dire and life-threatening to patients who need these drugs to survive.
Even if the drugs were to be kept in a fridge, the power situation in Nigeria precludes that, it only means that standards should be significantly raised to improve the quality of these drugs, and one cannot say what other drugs are poorly packaged and distributed as these.
It is more shocking
to read from the label that these copies of the ARV drugs are manufactured
under licence from the Federal Ministry of Health in collaboration with Millennium
Development Goals (MDGs) under the auspices of the MDGs 2009 Conditional Grant
Scheme. [UNDP NIG
(PDF)]
The label also has a NAFDAC Reg. No: A4-6854, which begs
the question of what standards of inspection and quality that organisation
imposes on drug manufacturing companies to ensure the general public are not
put at risk.
There is every
reason to believe that the manufacture of short shelf-life, poorly labelled,
badly packaged and low integrity ARVs means corners have been cut in the
system, somewhere between the bureaucracy and the businessmen who are probably
paid to do a better job than this.
Act now!
It is the duty of
everyone to ensure that the chain from sourcing of formulation through
dispensing to the patient ingesting the drugs is maintained to the highest
standard of manufacture and integrity for us to be confident that drugs meant
to save lives are not placebo effect dummies with no efficacious value.
I also hope
everyone involved including activists ensure that they are compromised and
bought off by the system where the lives of ordinary people are impacted.
When I was
contacted about this issue last month, the person had suffered a precipitous
fall in their CD4
count to 25% of what it was 6 months before. That is just unacceptable, and it indicates a sense of urgency and an emergency that needs to be addressed with immediate alacrity.
There were no other
indications in the bloods that could account for that result apart from the
Nigerian manufactured ARVs, and it would appear more of the Indian manufactured
ARVs are now being distributed in Nigeria.
