SEPTEMBER: SURGERY IN SICKLE CELL

Sometimes surgery comes as part of being a sickle cell and surgery generally is very stressful on the human body so let's imagine how much more stressful it will be on a patient with sickle cell.

As a sickle cell patient we are sometimes going to be faced with having to undergo surgery on an internal organ, or bone. I am not saying we all will but quite a few of us do so. Personally I have had two surgeries. The first one was a Caesarean Section and the second was a laparoscopic cholecystectomy which is the removal of my gall bladder. I had cholecystitis.

For both surgeries, general anaesthesia was used. General anaesthesia (GA) is a combination of drugs that cause sedation, paralysis, amnesia and analgesia. They act together to help a patient undergo a painful traumatic surgical procedure without any sensation which is actually the Greek meaning of ANAESTHESIA. The main mode of action of GA is on the central nervous system. It suppresses the CNS which results in the above mentioned characteristics. Like with all drugs, there are side effects to GA which is why before heading for surgery the anaesthesiologist responsible for you life and health, literally and figuratively, comes in to ask questions, personal and somewhat uncomfortable questions which we have to answer truthfully 100% and not intentionally omit or distort any truth because it could mean the difference between a disastrous and successful surgery. They ask questions on past surgeries you may have had including dental procedures,  there's mouth inspection too, age, on allergic reactions to foods, fruits and drugs, history of substance abuse, what drugs you are on both orthodox and herbal drugs, blood transfusion history and some other questions I cannot remember now. These will help them decide the right anaesthetic dose and duration and what to look out for during and after surgery.

Some of the risks of GA include postoperative vomiting, nausea, death, pulmonary embolism (this is blocking of the pulmonary artery which transports blood from the heart to the lungs by blood clot, air or fat) which in sickle cell can cause acute chest syndrome (ACS) and death. As mentioned above GA acts on the CNS and the CNS as we know from secondary Biology controls the activities of the body, it comprises of the brain and spinal cord. So if it controls our entire body activities and GA suppresses its activities we can only guess how very conscious and precise our anaesthesiologist must be. They have to monitor our hearts and lungs by our vital signs (blood pressure, pulse and breathing rate) since we cannot, move talk or tell them what could be wrong during the procedure.

It is the duty of the lead surgeon to tell the patient and relatives of the patient all the risks involved during and after the surgery and the means by which they can be prepared to prevent such from happening or if they happen the means by which to treat it. You should never go in for a surgery half prepared or relying on Faith without action. It does not work that way. I realize in Africa we have fear of being told the truth and we consider the messenger as the cause of the probable effect. Some people go on to harass the nurse or Dr who informs on what might happen so they have stopped telling us and just say everything will be fine then it goes wrong and the patients are left in chaos and confusion on what and how to solve such emergent issues.

Surgery does not have to be a death sentence. Be informed! Information is key to better health. 

SEPTEMBER: HARASSED WHILE HELPLESS

My name is *Sabrina Fahdeddeen I am 25 years old and I was born with sickle cell anaemia (of course I was, it isn't a communicable dx or a dx that is acquired later on on life) all the same, I live with my aunt who is a working class lady and the only relative I have (who's willing to take care of me) she lost her daughter to sickle cell and then took me as hers when I lost both parents in an accident. She has taken very good care of me and shown me love  and care exactly like my mother would. Last year, 2017 I had a major, major sickle cell crises while she was on a business trip overseas. It was the longest and toughest I have had in a long time. Actually before that I have not had crises in 6 years! I do not know if this counts as an experience of a sickle cell  patient but I feel the need to say this as I have not been able to talk to anyone just yet.

When the crises started I sent my aunt a Whatsapp message informing her about it, since it was very late at night and there was nothing I could do except wait for morning. In the morning I went to the private clinic in which she registered us and I was attended to. In the clinic there was this particular Dr who never greeted patients, was rude and pompous and once I was passing by and heard him yelling at a helpless patient something about the patient setting his own line by himself. I was completely shocked. A few hospital visits later I found out his name and spoke to him politely about the first time I saw him and how he treated that patient. He kept trying to make excuses that some patients are annoying and frustrating. Well boss, I know. I am a patient and have been one forever. We try our best and trust me, the majority of us do not ever want to be in your consulting room nor emergency room. But here we are...like we say in pidgin English "na condition make crayfish bend" so you as a Dr or nurse MUST control yourself and be understanding, patient and tolerant. If we could set our IV lines, we would do so at home. If we knew the right drugs and doses to take we would take them at home, peacefully without bugging you or ourselves going to the hospital.

His name was Dr. *Halilu Abubakar and I talked to him about his treatment of patients and his need to develop more patience with them. He was the one who got to attend to me. I was admitted in a single room and the nurses and attendants were all kind and polite to me,checking on me and taking care of everything I needed before my aunt would return to take over. Dr. Halilu was also among those who would check on me between his rounds and clinic.

One evening while a new IV line had just been set for me on my foot and I was given double dose of pentazocine and half promethazine which all made me sleepy, sleep and generally sedated, and pain  free, Dr Halilu came into my room and started putting his hands up my sleeping T-shirt and squeezing my breasts, he raised the T-shirt and started sucking my breasts as well. I would open my eyes and ask him to stop, tried to push him away but I could not make any sudden movements so as not to disrupt the IV fluid flow. I tried to scream as well but was so sleepy and weak all I could do was beg weakly between sleep for him to stop.  He got beside me and put one of my hand on his penis. He continued like this for quite a while, I cannot say how long, but he finally got up and left. He came back the next day while I was in the same condition and did the same thing. It was terrible and this time I cried begging him with tears to stop but still couldn't make enough sound to attract attention. Finally he left. He came back the third day but I was on very little pentazocine so I was not sleepy or as week. I screamed out when I saw him step into the room. I screamed for him to get out and he kept trying to calm me. But I kept yelling "get out! Get out!" until he finally did.

I was in the hospital for about two weeks, my Aunt had returned, continued taking care of me till I was discharged. He never came back to see me. After being discharged I went for followup clinic and I saw him. I confronted him, asked him why he did what he did and he said it was to help me feel better. I was stunned, and asked which part of medicine were they taught to sexually touch a helpless person who was asking and begging  for it to stop ? He just kept insisting he wanted me to feel better. I had to walk away from him but I will never forgive him not forget.

NB: *All names have been changed to protect the privacy of story teller

SEPTEMBER

What do we know about September? Some will say it is the ninth month of the year. Some will say it ushers in the autumn. Some will say they were born in September. Some will say their loved ones were born September. Some will say they lost a loved one in September. Some will say they got married in September. Some will say "it is Fatum's birthday month" *winks* September is so many different things to so many different persons but one thing we all have in common with September is the dedication of this month as Awareness month to Sickle Cell Disorder.

September is Sickle Cell AWARENESS month!!!

Wait a minute...I thought we had something sickle cell-ish in June? Yes Ma'am, we had World Sickle Cell DAY on June 19. Did I hear you grumble? You feel it's too much days for "just" sickle cell? I am SHOCKED by your attitude!

Do you know Sickle Cell Disorder is one of the highest genetically inherited blood disorder? 

Do you know it is among the highest cause of under 5 mortality rates esp in Africa?

Do you know there are different types of sickle cell disorders depending on race and region?

Do you know people living with sickle cell are among those who are stigmatized?

Do you know sickle cell patients are among those who are at risk of abusing drugs?

Do you know people living with sickle cell are highly prone to being depressed?

Do you know sickle cell patients are among the smartest, brightest and most intelligent when it comes to cognitive abilities?

Do you know friends and family of sickle cell patients can spend at least half their lives shuttling from home to hospital?

Do you know sickle cell disorder has no widely accepted and affordable cure yet?

Do you know sickle cell patients are prone to any other disease? You think of a disease and yes, we can develop it!

Do you still need me to go on about sickle cell disease?

Well, there is a lot many of us do not realize about sickle cell so we can and must dedicate a whole month to this disease. We just want everyone in every part of the universe to be AWARE...maybe one day we'll move to Neptune so, yes, the UNIVERSE has to be aware!

The truth remains sickle cell cannot be eliminated it will be very unrealistic to say that is the aim of awareness. In West Africa, for instance, we need the HbS (haemoglobin S) gene to be able to survive the malaria parasite. Persons with the sickle cell trait (HbAS), that is,  they have a normal gene HbA and an abnormal gene HbS, have been shown to have very high resistance to Malaria parasites. This can be related to their red blood cells (RBCs) not being completely healthy to support the thriving of the parasite yet not completely sickly to have an effect on the RBCs.

Have I made sense so far? No? Please do not hesitate to post your questions in the comments. Thank you.

Thanks to some very lovely persons, I will be posting different experiences of patients and relatives of sickle cell patients through out September. In no particular order of days and their names will be interchanged for privacy purposes.

God bless you <3