Friday, August 07, 2009
A Lagos Initiative: actualizing the United Nations Millennium Development Goal 5
In September of 2000, world leaders agreed on a blue print to foster all round development globally, especially amongst developing nations. Dubbed the Millennium Development Goals, it has been adapted into national planning and strategic development. There are eight goals, of which the United Nations Millennium Development Goal 5 is to improve maternal mortality; it has as its target to reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. There are two indicators for monitoring Goal 5; these are maternal mortality ratio and the proportion of births attended by skilled health personnel, but at the World summit in 2005, heads of government agreed to establish a new target under MDG 5 to achieve universal access to reproductive health by 2015. In 2005, more than 500,000 women died globally during pregnancy, childbirth or in the six weeks after delivery. Ninety-nine per cent of these deaths occurred in the developing regions, with sub-Saharan Africa and Southern Asia accounting for 86 per cent of them. In sub-Saharan Africa, a woman’s risk of dying from treatable or preventable complications of pregnancy and childbirth over the course of her lifetime is 1 in 22, compared to 1 in 7,300 in the developed regions. No evidence of significant change has been made since then and the achievement of the goal remains a daunting task. Lagos State Government has therefore decided to take the bull by the horn, and secure the lives of its citizenry, especially the women and children.
The United Nations in its Millennium Development Goals Report of 2008 identified that skilled health workers (trained doctors, midwives, and nurses) at delivery are key to improving outcomes. Assistance by appropriately trained health personnel, with proper equipment and referral options in case of complications, must be standard practice during deliveries if there is to be a noteworthy drop in maternal deaths. One of the major strategies that has been proposed by experts is Integrated Maternal and Child Centres (MCCs), as well as Emergency Obstetric Care (EMOC) training. A partnership that includes the World Health Organisation (WHO), United Nation Fund Population Administration (UNFPA), Joint United Nations Programme on Acquired Immune Deficiency Syndrome (UNAIDS), World Bank, United Nations Children Education Fund (UNICEF) and the Federal Ministry of Health and some States’ Ministry of Health including Lagos State has identified the need to integrate newborn, child health and maternal care interventions through the Integrated Maternal, Newborn and Child Health Strategy (IMNCH), in order to dramatically reduce child and maternal mortality by 2015.
Both manpower and infrastructure are being upgraded by the Lagos State Government. Capacity building for medical staff presently working in the various obstetrics and gynaecology departments of the general hospitals across the State and the State Teaching hospital is the major aim of running EMOC training in the state. This will also aid in preparing midwives and junior doctors for commencement of operations in the Maternal and Child Centres that are about to be commissioned in Lagos State.
The three day training course spread over a month comprises of informative lectures, group and interactive discussions, practical demonstrations using life-sized mannequins and illustrations. The lectures are developed with the intent of enhancing the practice of evidence-based medicine which is the most up to date method of health care delivery globally, keeping the participants abreast of international standards. The courses were commenced in April 2008 and since their inception they have been conducted every month except for July & august 2008; and in this year 2009, courses have been taught every month except January. In the first quarter of the year, ended in April, 103 medical personnel have been trained, including 19 doctors and 84 nurses. The feedback from the trainees has been overwhelmingly positive with each one commenting that their knowledge base has been improved and they have acquired new and current information.
Topics have been painstakingly selected to cover epidemiologically significant causes of death in obstetrics including: Management of Shock in Obstetrics (loss of blood in pregnancy); Hypertension (high blood pressure) in Pregnancy; Eclampsia and Pre-eclampsia (seizures and high blood pressure); Intra-partum Fetal Monitoring (observing fetus in pregnancy); Evidence Based Good Labour Ward Practice; Breech Presentation (Fetus with leg first) and Management of Obstructed Labour; Management of Early Pregnancy Failures such as threatened abortion, incomplete abortions, ectopic pregnancy (fetus not in the womb); Management of Pueperal Sepsis (infection surrounding pregnancy); Ante-Partum and Post-Partum Haemorrhage (bleeding per vagina in period around pregnancy). As the EMOC and Good Labour ward practice courses are designed and taught using evidence based medicine, they remain a unique innovation by the State.
The International Practical Obstetrics course that was also introduced last year exposes Lagos State Obstetric health workers to practical manoeuvres used in emergency obstetrics. These courses are taught by trainers from the United Kingdom who are instructors of the renowned ALSO (Advanced Life Support in Obstetrics) course and are expertly delivered. The ALSO course is accredited by the American Academy of family Physicians, U.S.A.
Lagos State has also designed a 110 bed integrated maternal and child centre that are being built in strategic areas across the state. Each of these centres will have five clinics for mothers, their babies and children, with emergency services, labour ward with delivery room, a theatre for doing caesarean section in complicated deliveries, wards for mother with complications before delivery, for mothers with their babies after delivery, a fully fledged ward for babies and children and neonatal unit for premature babies.
The construction of 110 bed integrated maternal and child centres is nearing completion in Ikorodu, Isolo and Ifako Ijaiye General Hospitals. Other locations where work has also started are Gbaja Surulere, General Hospital Ajeromi, Amuwo Odofin.
These centres are health facilities for pregnant women and their children which incorporate preventive and first contact care (primary health care) and intermediate level curative or hospital care (secondary health care) under one roof. Women can attend these centres from the time when they get pregnant until delivery and during the post-delivery period, and continue to attend after their children are delivered till they become adolescents. The centres would collectively provide an additional 66 per cent capacity to the available State maternal and child specialist facilities. The catchment population to be serviced by these facilities are Ikorodu (1.4m), Ifako-Ijaiye (199,000), Isolo (1.33M), Gbaja-Surulere (1.08M), Amuwo-Odofin (684,000), Ajeromi (1.47M) and Ibeju Lekki (620,000). The local people in these areas will be the beneficiaries of the facilities in these centres and the aim is to take pressure off the current big central hospitals.
This unrivalled vision, dogged commitment for capacity building, and training and re-training of staff are definitely ingredients any government need put in place to actualize the United Nations Millennium development Goal 5.
The United Nations in its Millennium Development Goals Report of 2008 identified that skilled health workers (trained doctors, midwives, and nurses) at delivery are key to improving outcomes. Assistance by appropriately trained health personnel, with proper equipment and referral options in case of complications, must be standard practice during deliveries if there is to be a noteworthy drop in maternal deaths. One of the major strategies that has been proposed by experts is Integrated Maternal and Child Centres (MCCs), as well as Emergency Obstetric Care (EMOC) training. A partnership that includes the World Health Organisation (WHO), United Nation Fund Population Administration (UNFPA), Joint United Nations Programme on Acquired Immune Deficiency Syndrome (UNAIDS), World Bank, United Nations Children Education Fund (UNICEF) and the Federal Ministry of Health and some States’ Ministry of Health including Lagos State has identified the need to integrate newborn, child health and maternal care interventions through the Integrated Maternal, Newborn and Child Health Strategy (IMNCH), in order to dramatically reduce child and maternal mortality by 2015.
Both manpower and infrastructure are being upgraded by the Lagos State Government. Capacity building for medical staff presently working in the various obstetrics and gynaecology departments of the general hospitals across the State and the State Teaching hospital is the major aim of running EMOC training in the state. This will also aid in preparing midwives and junior doctors for commencement of operations in the Maternal and Child Centres that are about to be commissioned in Lagos State.
The three day training course spread over a month comprises of informative lectures, group and interactive discussions, practical demonstrations using life-sized mannequins and illustrations. The lectures are developed with the intent of enhancing the practice of evidence-based medicine which is the most up to date method of health care delivery globally, keeping the participants abreast of international standards. The courses were commenced in April 2008 and since their inception they have been conducted every month except for July & august 2008; and in this year 2009, courses have been taught every month except January. In the first quarter of the year, ended in April, 103 medical personnel have been trained, including 19 doctors and 84 nurses. The feedback from the trainees has been overwhelmingly positive with each one commenting that their knowledge base has been improved and they have acquired new and current information.
Topics have been painstakingly selected to cover epidemiologically significant causes of death in obstetrics including: Management of Shock in Obstetrics (loss of blood in pregnancy); Hypertension (high blood pressure) in Pregnancy; Eclampsia and Pre-eclampsia (seizures and high blood pressure); Intra-partum Fetal Monitoring (observing fetus in pregnancy); Evidence Based Good Labour Ward Practice; Breech Presentation (Fetus with leg first) and Management of Obstructed Labour; Management of Early Pregnancy Failures such as threatened abortion, incomplete abortions, ectopic pregnancy (fetus not in the womb); Management of Pueperal Sepsis (infection surrounding pregnancy); Ante-Partum and Post-Partum Haemorrhage (bleeding per vagina in period around pregnancy). As the EMOC and Good Labour ward practice courses are designed and taught using evidence based medicine, they remain a unique innovation by the State.
The International Practical Obstetrics course that was also introduced last year exposes Lagos State Obstetric health workers to practical manoeuvres used in emergency obstetrics. These courses are taught by trainers from the United Kingdom who are instructors of the renowned ALSO (Advanced Life Support in Obstetrics) course and are expertly delivered. The ALSO course is accredited by the American Academy of family Physicians, U.S.A.
Lagos State has also designed a 110 bed integrated maternal and child centre that are being built in strategic areas across the state. Each of these centres will have five clinics for mothers, their babies and children, with emergency services, labour ward with delivery room, a theatre for doing caesarean section in complicated deliveries, wards for mother with complications before delivery, for mothers with their babies after delivery, a fully fledged ward for babies and children and neonatal unit for premature babies.
The construction of 110 bed integrated maternal and child centres is nearing completion in Ikorodu, Isolo and Ifako Ijaiye General Hospitals. Other locations where work has also started are Gbaja Surulere, General Hospital Ajeromi, Amuwo Odofin.
These centres are health facilities for pregnant women and their children which incorporate preventive and first contact care (primary health care) and intermediate level curative or hospital care (secondary health care) under one roof. Women can attend these centres from the time when they get pregnant until delivery and during the post-delivery period, and continue to attend after their children are delivered till they become adolescents. The centres would collectively provide an additional 66 per cent capacity to the available State maternal and child specialist facilities. The catchment population to be serviced by these facilities are Ikorodu (1.4m), Ifako-Ijaiye (199,000), Isolo (1.33M), Gbaja-Surulere (1.08M), Amuwo-Odofin (684,000), Ajeromi (1.47M) and Ibeju Lekki (620,000). The local people in these areas will be the beneficiaries of the facilities in these centres and the aim is to take pressure off the current big central hospitals.
This unrivalled vision, dogged commitment for capacity building, and training and re-training of staff are definitely ingredients any government need put in place to actualize the United Nations Millennium development Goal 5.
Wednesday, May 13, 2009
Wednesday, March 11, 2009
Doctor or Driver?????
Alright! Hello there. I know it's been a century that I updated this blog, but hey can you blame me, I had to face the vicissitudes of medical school, finally bagged my degree, and now a qualified medical doctor.
Now, please take a good look at the pictures above, do you think I am in the right profession?
Wednesday, January 31, 2007
The UN decolonisation program
The Charter of the United Nations recognises the right of peoples to self determination (*6). It also recognises that, largely because of colonialism, not all peoples who claim this right will be immediately able to exercise it fully (*7). Peoples in this situation are deemed to be in non-self-governing territories and for them the UN General Assembly has established de-colonisation programs (*8).
In 1963 Western Sahara was included in the UN list of the non-self-governing territories and in October 1964 the UN Decolonisation Committee (*9)adopted its first Resolution on Western Sahara, urging Spain to start the process of decolonising the territory (*10). The UN General Assembly issued a similar Resolution on December 16, 1965 (*11).
Initially, Spain resisted this call but in August 1974 it informed the UN that it was prepared to organize a referendum on self-determination in the territory. In this referendum, the people of Western Sahara could choose either full independence or to remain attached to Spain (*12). Morocco and Mauritania opposed the referendum idea, which excluded the possibility of integration with Morocco or Mauritania. Between 12 and 19 May 1975, a UN mission of inquiry was sent to report on the situation in Western Sahara. The mission visited Western Sahara, Morocco, Mauritania and Algeria. In its report, it stated that support for Polisario and for independence in Western Sahara was widespread and recommended the holding of a referendum for self-determination (*13).
In 1963 Western Sahara was included in the UN list of the non-self-governing territories and in October 1964 the UN Decolonisation Committee (*9)adopted its first Resolution on Western Sahara, urging Spain to start the process of decolonising the territory (*10). The UN General Assembly issued a similar Resolution on December 16, 1965 (*11).
Initially, Spain resisted this call but in August 1974 it informed the UN that it was prepared to organize a referendum on self-determination in the territory. In this referendum, the people of Western Sahara could choose either full independence or to remain attached to Spain (*12). Morocco and Mauritania opposed the referendum idea, which excluded the possibility of integration with Morocco or Mauritania. Between 12 and 19 May 1975, a UN mission of inquiry was sent to report on the situation in Western Sahara. The mission visited Western Sahara, Morocco, Mauritania and Algeria. In its report, it stated that support for Polisario and for independence in Western Sahara was widespread and recommended the holding of a referendum for self-determination (*13).
A whole new experience
Really, there is no way I can explain this tha t it would express the way I feel, but I guess I just have too. I was selected out of a keenly contested screening exercise to represent my university at the 2nd Nigerian Model United Nations in Portharcourt, Nigeria, last year November. This was my first time attending such a program, and I am excited I did.
At the General Assembly, I was representing Argentina in the Committee of Non Govermental Organizations. I was elected as President, General Assembly of theNigerian Model United Nations. This year has been wonderful. A lot of stuff has come with this honoured position. I met distnguished people, and highly intellectual Nigerian students.
I invite you to join us at Abuja 2007. It would be my greatest pleasure to have you in Abuja.
At the General Assembly, I was representing Argentina in the Committee of Non Govermental Organizations. I was elected as President, General Assembly of theNigerian Model United Nations. This year has been wonderful. A lot of stuff has come with this honoured position. I met distnguished people, and highly intellectual Nigerian students.
I invite you to join us at Abuja 2007. It would be my greatest pleasure to have you in Abuja.
Wednesday, June 28, 2006
An innocent baby & an unfortunate doctor
Two weeks back, there was a report in the newspaper about a little baby who was transfused with HIV positive blood, and is now showing symptoms of full blown AIDS.
Now this is the story, The baby was brought into the emergency clinic with need for an urgent blood transfusion, the father eventually offered to donate blood which as it the practice is not necessarily used to transfuse the baby but replaced in the blood bank. Another bag was taken out of the bag, and transfused to the baby, there were no improvements, and the baby started wasting. Diverse tests were carried out to ascetain what could be the problem. When the XYZ text (HIV) was carried out, the baby tested positive. How come? The father's blood and mother's blood samples were tested, and were found to be negative. When the donor from which the blood that was transfused to the baby was tested, he tested positive. Investigations commenced, and it was discovered that the donor tested negative at the time of donation. The donor was probably just seroconverting when his blood was taken, and the viral load was not high enough to be detected. The baby who had no preformed immunity against the Human Immunodeficiency virus now has symptoms of AIDS. Accusing fingers have been pointed at the doctor, some have said it was his fault, some have said it was machine error, some have blamed the hospital for not having up to date equipment to detect the least viral load.
The big question is Who is at fault?
Now this is the story, The baby was brought into the emergency clinic with need for an urgent blood transfusion, the father eventually offered to donate blood which as it the practice is not necessarily used to transfuse the baby but replaced in the blood bank. Another bag was taken out of the bag, and transfused to the baby, there were no improvements, and the baby started wasting. Diverse tests were carried out to ascetain what could be the problem. When the XYZ text (HIV) was carried out, the baby tested positive. How come? The father's blood and mother's blood samples were tested, and were found to be negative. When the donor from which the blood that was transfused to the baby was tested, he tested positive. Investigations commenced, and it was discovered that the donor tested negative at the time of donation. The donor was probably just seroconverting when his blood was taken, and the viral load was not high enough to be detected. The baby who had no preformed immunity against the Human Immunodeficiency virus now has symptoms of AIDS. Accusing fingers have been pointed at the doctor, some have said it was his fault, some have said it was machine error, some have blamed the hospital for not having up to date equipment to detect the least viral load.
The big question is Who is at fault?
Friday, March 18, 2005
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