Dr. Sylvester Ikhisemojie
Published 26 December 2021
Babatunde and Nancy are a couple with disabilities. Babatunde, 38, has profound hearing loss and an added physical handicap having survived polio in childhood. Nancy, 29, is deaf with educable mental retardation. Three years into marriage, the couple was yet to have a baby. Many attempts at conception had proved abortive. Depending on their own unique understanding of what conception is, they had intercourse nearly every night and tried various positions to make sure that they were doing what is right. The disabled couple was unable to communicate with anybody else in connection to their problem. They were shy of the fact that people from within and outside of the disability community were going to laugh at them. Even when they willingly visited doctors, Babatunde found that he could not physically access many hospitals. In fact, “the doctors could not understand us because I am deaf and unable to speak while Nancy does not understand information easily”.
About three years after and with considerable pressure from their parents, the couple went to see a doctor with direction from their unique community. First, there were immense physical difficulties with accessing the hospital due to the challenging mobility issues that Babatunde has. At the clinic, there was a complete lack of communication. Interpersonal communication between the doctor and the couple was the only available way forward. Neither partner could speak nor write. As a result, the doctors couldn’t determine what the issues were before determining what useful investigations to recommend with regards to their reproductive health. The attending gynaecologist who also had a lot to share with them regarding conception for new couples was unable to do so due to the challenges posed by difficult communication between the health care staff and this couple. Dejected, the couple resolved that “God’s time was the best.” They continued to live in their blissful cocoon.
Five years into their marriage, a certain non-governmental organisation seeking to empower women and girls with disabilities had organised a symposium to bring individuals together around a reproductive health conversation. Attendees were encouraged to communicate, to share their current and existing sexual health experiences. They also listened to the stories of fellow participants. At the end of the seminar, the couple went away with new pieces of information that transformed their lives forever. Three months later, Nancy became pregnant! What had been wrong? It turned out that she had no knowledge of important female reproductive yardsticks and practices, including ovulation, and how it related to the process of conception. Neither did Babatunde understand simple terms such as sperm count and the need to sometimes time the act of having sex. But this is one out of a large number of real-life stories and experiences about the sexual and gynecological health problems of females with disabilities.
Given the unprecedented attention that members of the disability community have been receiving from an increasingly more inclusive and more tolerant global village, and yours truly’s own professional experiences with these individuals seeking medical reproductive attention, this article examines a momentous reproductive health challenge and the associated negative impact faced by members of the disability community in Nigeria.
There is a growing number of cases of people with disabilities, particularly among deaf and blind people who are having trouble with conception. But this problem is also increasing in the wider society and the causes vary. Perhaps, one reason why the incidence of infertility among people living with disability is becoming more evident is because of better access to modern health care. Therefore, females with disabilities may be at a protracted disadvantage due to ignorance and a lack of the ability to communicate outside of their community.
Poor reproductive health knowledge and habits remain a challenge among those who are deaf and dumb. This is mainly a consequence of their communication difficulties. Knowledge and awareness of reproductive attitudes and practices are really important. However, the lack of information about these needs, the indifference of the general populace not to mention our governments at every level goes further to worsen these challenges. It is a philosophy of governance that the strength of a nation is determined not by its economic success or its military might but by the attention it pays to the disabled among its people. There is segregation in Nigeria and very often, people even laugh at these worthy individuals. Researchers believe that the inherent difficulties of people with disabilities in engaging within the wider society have cost them dearly with reproductive and other issues to do with their overall well-being. Some of these challenges have to do with these members of the disability community having to endure denial of the right to establish civil relationships.
Persons who are blind, deaf, or have intellectual or cognitive impairment find that information on sexuality and reproduction is often inaccessible to them. Moreover, because of lack of disability-related technical and human support, stigmatisation and discrimination, sexual and reproductive health services are often inaccessible as well. During a recent visit to a middle-income country, one was truly surprised to see a pack of an antibiotic powder designed for use in children come also with instructions in Braille at the side of the packet. That is a thoughtful society indeed.
The ignorance and attitude of society and individuals, including health care providers, raises most of these barriers, not the disabilities themselves, and increase their feeling of being ostracised. These common factors are itemised below;
-Poor access to reproductive health services
-Ignorance and lack of knowledge about reproductive health
-Poor or lack of standard sources of reproductive health information
-Poor reproductive health behaviours, such as poor hygiene, persistent sexual and behavioral risks and poor basic sanitation,
-Inaccessibility to good reproductive health information. Now, new and emerging diseases are contributing to a deadly mix that is changing the classic picture of healthy adolescents even in these communities.
These factors serve as barriers to receiving the reproductive health care services that these people need because ironically, the individuals with a disability do have a greater need for sexual and reproductive health education and care than persons without disabilities due to their increased vulnerability to sexual abuse, lack of information and access to services.
QUESTIONS AND ANSWERS
QUESTION 1: Good day, doctor. I missed your essay two weeks ago but I am glad that you returned this week with that article about stuffy nose. I am a 78-year-old man and I always wake up in the morning with a dry throat. I am hypertensive and well-controlled on my regular medications but since I started to experience this problem about six weeks ago now, I also have to wake up during the night to sip some water. This leaves me very concerned, especially because when I wake up in the morning I breathe normally. Besides all that, I also have some serious pain in the neck which my doctor said is cervical spondylosis based on the X-rays he requested that I have. My doctor has given me some medicines to use but there has been no improvement. What is your advice regarding what I am to do about these problems? Thank you very much. God bless you. 0803XXXXXX5
ANSWER: Thank you very much, sir for your support and your kind words. If this problem recently started, it may be due to the recent change in weather where we now have some degree of dryness around the country as a result of the harmattan. This can be the issue responsible for the dry throat you experience. The second factor is the kind of anti-hypertensive medication you are using; that can also be a contributory factor in making your throat dry. However, you do need some awareness that there is a distinction between our topic, stuffy nose and a dry throat, which you actually have. The causes of both are different and as your question noted, you are fine in the morning when you wake up. Finally, with regards to your neck, medications alone are not likely to deal with the problem you have: some physiotherapy and even the use of a cervical collar for several weeks may help to alleviate the overall discomfort in the neck. It is important to have this conversation with your doctor.
QUESTION 2: Good day, doctor. My daughter and I moved over to the United Kingdom just under two months ago and since then she has had severe fever roughly every two weeks. I first treated her with baby paracetamol and baby malaria syrup (Lonart) that we came here with and that seemed to help. She is five years old now and the fever keeps coming back. Lately, like 10 or so days ago, she also developed a mild cough. She is better now but for the fact that the fever keeps coming back. I thought I should seek expert advice. What do you think please? 0803XXXXXX5
ANSWER: Well, there are a couple of issues with your question and the first one is your use of baby paracetamol for a five-year-old child. That is not likely to give you an optimal response. The second one is your administration of baby malaria syrup; that is also likely to have been inadequate. In the main, you may be dealing with a situation of inadequate dosage for what would have been a relatively simple ailment to treat. However, with the arrival of winter in the UK, there will also be an upsurge in respiratory tract infections and allergic conditions as well as the flu. Any of these things will give your child a fever. You have two options; it is either you give a double dose of these medications to your daughter in the hope of ultimately giving her the ideal dosage, and that is if you still have them, or you visit a general practitioner for further directives with regards to her status. Without health insurance in the UK, you may have to pay in cash, which will not be a joke.
QUESTION 3: Good morning, doctor, I am sorry to disturb you at this time of the night but I am not able to sleep because of the kind of headache I have. It started a week ago and was located in the forehead with severe banging such that it was affecting my eyes. I saw a doctor in my school, who treated me for malaria and typhoid. I was given arthemeter injection for three days and ciprofloxacin tablets and the headache stopped. But it started again a few days after and I had to take amalar with paracetamol. Since then, it will stop and start again and last night it was so bad that I had to take propranolol. What do you think is the problem? Thank you very much. 0802XXXXXX2
ANSWER: The more likely thing with respect to your complaints is that you have probably not yet dealt with the malaria. It is possible to say this because the headaches seemed to respond well anytime you used an anti-malarial. Therefore, the good option for you is to have a repeat test conducted to look at your blood film and also a full blood count which will afford your doctor the proper insight into your current health. (This desperate message was received at 3.20am and by the next morning at daybreak, repeat investigations as directed above showed that this patient’s blood was still had malaria parasites). The use of another combination therapy eventually did the job.
QUESTION 4: Dear doctor, I like reading your health talk in the Sunday PUNCH. I am 56 years old. I noticed that I have been suffering from prostate cancer since some years ago. This has affected my sexual performance and I do not perform well again and this has reduced my interest in sexual intercourse. I have quick ejaculation and I have challenges with erectile dysfunction. For two years now, I have been under medication for hypertension, heart disease and high cholesterol. Sir, I want you to advise me on what to do. Thank you. 0706XXXXXX0
ANSWER: First of all, it is important to know if this prostatic cancer you mentioned has actually been diagnosed or you are assuming you have it based on what literature you have read about it. This clarification is important because your question says “I noticed that I have been suffering from prostate cancer since some years ago” but it makes the whole story unclear. At any rate, if you do have prostate cancer, the treatment involved, whether by medications or by surgery, will definitely have an adverse effect on your libido and sexual drive. The medications all have adverse hormonal effects which drive down your testosterone levels. To add all of that to medications used in treating your high blood pressure, heart problems and high cholesterol would definitely damage your sexual ability further. It is best for you to seek relevant audience with the doctors treating you.
QUESTION 5: Good evening, doctor. I am reaching out to you from Abuja. I am 32 years old and I have been having catarrh for the past two years now. I have taken some drugs but it is still there. Please help me to solve the problem. Thank you. 0806XXXXXX5
ANSWER: Good day to you, as well. Catarrh that has gone on for two years is most likely to be due to something else ranging from a sinus infection to a polyp inside the nostril. You will feel the discomfort in the throat because the secretions usually drip into that area of the head and neck but the disease is in the nose. Due to the range of possible causes of this condition, you will have to visit an ENT surgeon for appropriate diagnosis and treatment. This kind of story you have relayed here of catarrh lasting for so long has gone beyond the matter of buying drugs on your own. The correct diagnosis must first be made before your treatment can be meaningful. There are many good hospitals in Abuja, both private and public, and you will be well served if you visit any of them that has got an ENT surgeon at the direction of your doctor.
QUESTION 6: Good afternoon, doctor. I am a new mother breastfeeding my first child who is six weeks old now. But I have headache, eye ache, temperature and cough. I started cough medicine about two days ago but it is dry and I don’t cough anything out. I also have waist and muscle pains and I have a strong suspicion that I have malaria. Also, one part of my lip is swollen. I would like to know if I can take malaria drugs while breastfeeding. Thank you. 0807XXXXXX2
ANSWER: Yes, you can take anti-malarials while breastfeeding.
QUESTION 7: Good evening, doctor. I have this pain at the right side of my tummy towards the back area and it has been there for a while. I initially thought it was due to the sitting position I usually take when I am at school during lectures but the pain is just there; it is dull and persistent. I also easily get full when I eat even if the food is really small. This makes me so uncomfortable and I am wondering if I should go for an abdominal scan. Lastly, I don’t understand my blood pressure; the last check sometime around May this year was really high and I was placed on moduretic, nifedipine 30mg and lisinopril. I have maintained these drugs until now. The range then was 180/110mmHg, 150/100mmHg and so on, like that and I was suffering persistent headaches due to my examinations for which I was rarely sleeping at night. I am still trying to control it. Please what is your advice? 0809XXXXXX0
ANSWER: The medications you are currently taking may not be potent enough to deal with this blood pressure. Unfortunately, you did not disclose your age and we are left to make educated guesses based on the fact that you talked about having to sit through lectures and sitting up till late at night to study. That indicates that you are under 40 and maybe less than 30 years of age. If the latter is the case, you do have severe hypertension and are in dire need of urgent attention from none other specialist than a physician, but even more appropriately so by a cardiologist. The doctor who has placed you on the trio of medications should refer you to an appropriate specialist without delay so that every form of ultrasound scan plus other scans you might need will be recommended by your new doctor. At your age, therefore, a kidney component cannot be excluded and the earlier you act as suggested above, the better for you. I wish you well.
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